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Hartford Hospital School of Nursing 

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P. Blakiston, Son & Co., Philadelphia. 










Hartford Hospital School of Nff-f 




JUN 7 1967 

Copyright, 1889, by P. Blakiston, Son & Co. 


1220-24 SANSOV ST.. 



These lectures were recently delivered to the 
pupils of the Philadelphia Hospital Training School 
for Nurses. It was my intention to have them ap- 
pear in a medical journal, if they were published; 
but a strong desire that they should be presented 
in a more permanent form having been expressed, 
has led me to change my first purpose. 

The lectures are published as they were given, 
only a few eliminations having been made ; but as 
some important topics were omitted, or only par- 
tially presented, these are considered, in alphabetical 
order, in an appendix. 

My hope is that this little work may prove in 
some degree interesting, instructive and useful to 
those engaged in the stud}* of obstetric nursing, and 
thus through them do £ood to all unto whom thev 
may be called to minister. 

July, 1889. 


Lecture First: 


Introductory, 9 

Meaning of the Word Nurse, n 

Training Schools for Obstetric Nurses, 16 

Special Responsibility of the Obstetric Nurse, 23 

Qualifications of the Obstetric Nurse, 28 

Reasons for Giving up an Engagement, 32 

The Duties Before Labor, 34 

Expression of Opinions as to Doctors, 40 

Criticisms of Other Nurses, 42 

Position in the Family, of the Nurse, 42 

Silence as to Family Affairs, . 43 

Visits of the Clergy to the Sick, 44 

Premonitions of Labor, 45 

Preparation for Labor, 48 

Lecture Second : 

Sepsis, Antisepsis, Septicaemia, 51 

Asepsis and Antisepsis in Practice, 55 

Condition of Bowels and Bladder, 56 

Food and Drink, 57 

Position in First Stage of Labor, 58 

Premature Discharge of the Waters, 58 

Preparation of the Bed, 59 

The Patient's Clothing, 60 

Obstetric Examination, 61 

Scissors and Cord, 62 

Receiver, Bandage, etc., 63 

Temperature of Room — Bed Covering, 64 

Encouraging the Patient, and Exclusion of Persons not 

needed, 64 

Duration of Labor, 65 

Suffering of Labor — Use of Anesthetics, 66 

vii * 



Position During Second Stage of Labor — Attentions of the 

Nurse, 68 

Delivery of Child and Placenta by the Nurse, in the Absence 

of the Doctor, 71 

Removal of Soiled Cloths, Bathing and Bandaging, .... 75 

Raising the Hips for Removal of Soiled Bedclothes, .... 77 

Washing the Infant, 77 

Dressing the Cord, 80 

Evacuations from Bowels and Bladder of Infant, 82 

Applying Infant to Breast — Artificial Food, 82. 

Infant Should not Sleep with the Mother, 83 

Falling off of the Cord, and Dressing the Raw Surface, . . 84 

Attentions to the Mother, 84 

Food, 85 

Use of Catheter, 86 

Local and General Bathing, 87 

Temperature of the Patient, 88 

Time when the Patient May leave her Bed, 89 

Occupation During Convalescence, .... 90 


After- Pains, , . 91 

Antiseptics, 92 

Antiseptic Napkins and Pads, •-. . . 92 

Bed of the Puerpera, 94 

Breasts, Infant's, Care of, 95 

Breasts, the Mother's, Care of, 95 

Catheter, 97 

Colostrum, 97 

Constipation — Colic, 98 

Convulsions, Puerperal, 99 

Food for the Infant, 99 

Hemorrhage, Uterine, 101 

Lochia, 102 

Meconium, 103 

Septicaemia, 103 





The duty of delivering two lectures upon ob- 
stetric nursing to the pupils of the Training School 
for Nurses in the Philadelphia Hospital has been 
assigned me. This duty was cheerfully accepted, 
hoping that some useful things might be said which 
would help you to help those who suffer, and de- 
siring, too, to magnify your office, endeavoring to 
inspire you with hearty love for it, if such inspira- 
tion be needed, and earnest zeal in the discharge 
of its functions. 

How this instruction can be best given may be 
a question. A code of laws might be formulated ; 
but that, it seems to me, would be as lifeless as the 
bleached bones of a skeleton, and as little likely to 
awaken interest in those who listened to its enun- 
ciation as the multiplication table does in the child 



first compelled to commit it to memory ; still less 
would such a code evoke enthusiasm and invite 
consecration. Educated minds weary of formulae, 
or even may rebel against dreary dogmatisms, 
arbitrary rules and absolute imperatives. Shall 
and shall not sound like an echo of Sinaitic sove- 
reignty and solemnity. If a nurse were only an 
automaton, a mere machine with a motive power 
instead of an individual under the power of motives, 
a machine doing a definite amount of work in a 
fixed time and way, then positive laws, precise 
rules and peremptory commands might be given. 
Huxley once said, "I protest that if some great 
Power would agree to make me always think what 
is true and do what is right, on condition of being 
turned into a sort of clock and wound up every 
morning before I got out of bed, I should instantly 
close with the offer." Nevertheless, a human being, 
and especially an educated human being, is more 
marvelous than the Strasburg clock or any other 
ingenious product of human thought and skillful 
mechanism. Such person has intelligence, reason, 
conscience, affection, will, and the consciousness of 
responsibility; she cannot be wound up and made 
to go right by fixed laws and invariable rules, 
no matter how long a time is spent in the effort. 
The true nurse is not a manufacture, but an inde- 
pendent, growing personality ; intelligent brain, 


kindly nature, sympathetic heart and skilled hand 
must be united. She is a living soul as well as 
an active body, and the two must blend their forces 
to make her life a blessed harmony, a voice of praise 
and a power of doing the greatest good. 

While of old it was said that the law was a school- 
master, compelling to higher knowledge and holier 
help, my role to-day is neither to give nor to en- 
force laws, but rather to endeavor in plain speech 
to present principles out of which the intelligent 
mind will form rules of action, and make general 
description of the conduct of the obstetric nurse. 
Nevertheless, before entering this defined way, it 
-eemed to me that incidental light may be ob- 
tained by first considering the signification of the 
word nurse, and presenting the means that have 
been employed, more especially in this city, for 
instruction in obstetric nursing. Moreover, there 
will be added to these preliminary remarks certain 
reasons for holding that the office of obstetric nurse 
is invested with especial dignity and importance, 
thereby hoping to instill in those who devote them- 
selves to obstetric nursing greater love and higher 
honor for their work. If any flowers are str 
upon the way we walk, remember the motive :- 
render that way more attractive, and remember, 
too, that they are not artificial, but those which 
nature and history give. 


Meaning of the Word Nurse. — The word nurse, 
from the Latin nuirix, like that word, first meant a 
mother who supplied another's infant with the milk 
designed for her own — in other words, she was a 
wet-nurse. Indeed, so essential is this idea in the 
Latin word that its plural, nutrices, was applied to 
the breasts themselves. About the middle of the 
sixteenth century Tansillo, an Italian, wrote a poem 
entitled La Balia, that is, The Nurse ; and under 
this name it was translated by William Roscoe and 
published in London in 1798. This w r ork was an 
argument against the employment of la balia, or 
the wet-nurse, and a strong plea for maternal nurs- 
ing. The following passage illustrates the burden 
of the poem : — 

" O crime! with herbs and drugs of essence high 
The sacred fountains of the breast to dry ! 
Pour back on nature's self the balmy tide 
Which nature's God for infancy supplied ! " 

The word nurse occurs in Shakespeare between 
seventy and eighty times ; the most notable instance 
probably is in " Romeo and Juliet," where the nurse 
of Juliet was originally her wet-nurse, and con- 
tinued with her from infancy. It may be of interest, 
as showing an example of prolonged lactation, to 
state that Juliet was not weaned until she was three 
years old. For those who delight in the post hoc, 
ergo propter hoc method of reasoning — the number 


of such logical imbeciles is by no means small — 
there is a strong argument for early weaning in the 
case of girl babies, or at least against three years' 
nursing, in the sad fate which befell Juliet. 

The nurse meets us in many Greek plays, and in 
most the probability is she had been the wet-nurse, 
and was a permanent member of the household ; 
certainly this is the fact in one of the plays of 
^Eschylus, where the nurse of the matricide Orestes 
is introduced. In the " Trachiniae " of Sophocles 
the nurse occupies an important place, and her sad 
final words are too often verified in human lives : 
" Such is the state of circumstances here, so that if 
any one count on two days or more, he is foolish ; 
for there is no morrow before he pass without 
misfortune the present day." One of the noblest 
characters in the " Odyssey " is the nurse, the gray- 
haired Euryclea; she has been faithful in all the 
long years to that model of wifely fidelity and 
womanly love r Penelope, and she first recognizes 
" the much enduring, much experienced man," 
Ulysses, returned from his protracted and perilous 
wandering. She had been his wet-nurse, as these 
words addressed her by him plainly show : — 

"Thy milky founts my infant lips have drained." 

The word nutrix was also used, as is our word 
nurse, to designate one who supplied food to the 


feeble or sick. And undoubtedly this is one of the 
most important duties of the nurse. A great Dub- 
lin physician, many years dead, thought that the 
highest praise which could be given him after death 
would be in these words, " He fed fevers." Such 
eulogy pointed to the fact that chiefly by his teach- 
ing and practice those suffering with low forms of 
fever, once so prevalent in Ireland, were given a 
more liberal diet. There is a homely expression 
you may hear in some parts of our country, to sig- 
nify that a husband furnishes arj ample supply for 
the wants of a household, especially those relating 
to food, and it is, " He is a good provider." A good 
nurse will be a good provider for the sick, and it 
may be regarded as greatly in her praise that she 
secures for those under her professional care suit- 
able and sufficient food. But this is only one of 
her many duties. 

Her title has by use come to mean more than, or 
different from, the supply of natural or of artificial 
nutriment. She is one who takes care of the sick, 
the infirm, and of the convalescent. The French 
word garde — garde malade and garde d' accouche es — 
is a better word to indicate the duties of a nurse 
than that w r ord itself; indeed, it might be wisely 
adopted, changing the orthography so as to have 
the English guard, if that were not so suggestive of 
police power or of military control. 


The poets have employed the word nurse in a 
figurative sense, still, however, retaining the idea of 
supporting, sustaining, supplying with food, or 
maintaining. Thus Shakespeare calls Rome " the 
nurse of judgment." Chaucer, in one of the " Can- 
terbury Tales," says that sleep is the " norrice of 
digestion" ; in old French nurse was " norrice " or 
44 nourrice." 

Milton has said : 

" And wisdom's self 
Ofi seeks to sweet retired solitude, 
Where with Uer best nurse, Contemplation,' ' etc. 

Sir Walter Scott's lines are familiar to most : 

" O Caledonia ! stern and wild, 
Meet nurse for a poetic child ! " 

Robert Burns in " Tarn O'Shanter " uses thus the 
word nursing : 

" Where sits our sulky, sullen dame, 
Gathering her brows like gathered storm, 
Nursing her wrath to keep it warm." 

In the following passage from Dante we have also 
a figurative allusion to nurse: 

" But ye are sick, 
And in your tetchy wantonness as blind 
As is the bantling, that of hunger dies, 
And drives away the nurse." 

The idea of supporting, sustaining, developing, 
maintaining, inheres in the words nurse, nursing. 


The obstetric nurse has, it is true, to provide with 
suitable nourishment the puerperal woman; but she 
must do much more, protecting her from all injuri- 
ous physical as well as moral influences, caring for 
her by night and by day until her convalescence is 
complete. The lying-in woman is not, in the great 
majority of cases, sick, but only exhausted by the 
suffering and struggle of labor, as well as often 
weakened by the demands which pregnancy has 
made upon her vital power ; in a few weeks she 
passes through important physiological changes 
scarcely less marvellous than those belonging to 
gestation itself; though not sick, she is in-valid, 
and needs to be made valid ; she is like a dis- 
mantled fortress, broken-down defences permitting 
ready entrance of foes to health and life, and there- 
fore needs to be carefully, constantly, conscien- 
tiously guarded until those defences are restored, 
and her recovery accomplished. 

Training Schools for Obstetric Nurses. — It is 
fortunate for women who bear children that in 
recent years many trained obstetric nurses are 
supplied, and are gradually becoming generally 
employed. It is not long since such nurses were 
very few, but now there are many to be found, 
especially in our large cities, though taking the 
country over they are far from being in the majority. 
Time was, and that not very long since, when, as a 


rule, she who took charge of women in childbed 
did not enter upon her work until she was driven 
to it by pecuniary misfortune ; she was a widow, or 
worse, had a worthless husband, a drunkard, for 
example, and her children cried for bread, so that 
she sought it by nursing. She " went out nursing," 
as the expression was, rather than " take in " sewing 
or boarders — possibly the latter might in some 
cases have been taken in had she made the attempt. 
She preferred this occupation even to canvassing 
for a subscription book, gorgeous with gilt edges 
and lettering, rich in binding and cheap illustra- 
tions, but in literary character in the last stage of 
marasmus. Some of these enforced recruits of the 
great army of nurses had been well educated, pos- 
sibly brought up in wealth and luxury, and turned 
to their new duties broken in spirit if not enfeebled 
in body; frequently they were in middle life, or, 
this period passed, they were descending the last 
declivity. Occasionally the work was chosen, not 
from necessity, but because they who engaged in 
it wished to be usefully employed, or desired to be 
independent of the kindness of kindred or the 
generosity of friends. Thus, from the ranks of the 
unmarried a few became obstetric nurses. In this 
connection it is worthy of being stated that not 
only in Pagan mythology was a virgin the goddess 
especially presiding over childbirth, Diana, or Ar- 


temis, but that also, in the early Christian ages, a 
virgin was invoked by those who endured the mar- 
tyrdom of maternity. This saint was Margaret ; 
she was a very beautiful maiden of Antioch, a 
Christian, who, rejecting the marriage offer of a 
powerful and profligate heathen prince, suffered 
martyrdom and was canonized. 

Let me not say an unkind word of these women 
who, without any training, without experience, 
chose obstetric nursing as a mission, accepted it as 
a duty, or were compelled to engage in it to earn 
their daily bread, to keep the wolf from the door, 
to provide things honest for those dependent upon 
them. I know too well what excellent nurses 
many of them were, nay, how excellent many of 
them are. Kind-hearted and quick-witted, obedient 
to the physician's directions, and learning by expe- 
rience, they were faithful and successful. When a 
doctor recognizes a good nurse he is satisfied, and 
does not ask how her knowledge was obtained. To 
make such inquiry, quoting from one of Moliere's 
plays, " is just as if a man were to taste a capital 
sauce, and wished to know whether it was good 
according to the recipe in a cookery-book." I will 
go still farther, saying that many a time I have met 
with self-educated nurses who were wiser, more 
faithful, more intelligent, so far as the practical 
duties of their calling were concerned, than a 


trained nurse who had become a mere automaton, 
blindly following a doctor's directions as she. heard 
and read them without ever stopping to think, to 
recall and to re-read those words, until her patient 
was being swiftly borne to inevitable death as the 
consequence of her mis-hearing and mis-reading. 
It is the individual rather than her training that 
often determines the value of a nurse. " With what 
do you mix your paints?" said a pert questioner 
to the great painter Opie ; and the reply was, 
"With brains, sir." Those who would succeed in 
their work as nurses need brains — above all, that 
cerebral manifestation known as common sense, so 
termed, it may be, because it is sometimes, at least, 
found so uncommon. One hears every once in a 
while in these days a denunciation of the expression 
"born nurse" as a gross heresy. So it is if we 
thereby mean birth is everything, training nothing ; 
but if we mean that some women, in consequence 
of original endowments and aptitudes, make the 
best nurses, while training, no matter how tho- 
rough and long-continued, will not make good 
nurses out of others, there is truth in the expr 
sion. Blood tells in horses, in men and in women. 
A colt, no matter if sprung from the best rac: 
ancestry, does not win the Derby without having 
been well trained for the contest ; and another, if 
derived from inferior stock, no matter how much 


training may be given, never attains a better gait 
than that required for a city funeral procession. 

But to return from this digression ; now, instead 
of those who are enfeebled by age, or victims of 
pecuniary misfortune or of disappointed hopes, we 
see the brave and young, in the full vigor of life 
and generous ardor of hope, cheerfully choosing 
the employment of a nurse, qualifying themselves 
by suitable theoretical and practical studies, and 
then entering upon their work, not as a compulsory, 
tiresome and exacting trade, but as a loved and 
honored profession. This noble army is a testi- 
mony to the higher development of obstetrics, and 
its faithful members have already been important 
factors in lessening alike the morbidity and mor- 
tality of childbed. 

Dr. J. Wallace Anderson, in his admirable lec- 
tures upon Medical Nursing, thus refers to the "real 
beginning of the systematic training of nurses : " 
" It dates from 1836, when Theodore Fliedner, the 
pastor of a small Protestant congregation at Kaisers- 
werth on the Rhine, established in that little Ger- 
man village what he called the Deaconess Institu- 
tion. There, under the superintendence of himself 
and his wife, a training school for female nurses 
was begun. It was carried on from the first in a 
markedly devotional spirit, and was based on the 
principle of the Deaconess Institutions of the early 


Church. Fliedner's institution was therefore quite 
a religious community, but with no vows, as the 
founder always said, the only bond of union being 
the Word of God. It still flourishes, along with 
many others on the Continent which have followed 
in its path, and has been the training school of many 
a leader of the work in our own country. Pastor 
Fliedner died in 1864. I think there can be no 
doubt he is entitled to be considered the founder 
of modern nursing." 

Let us not, however, think that the training of 
obstetric nurses is altogether a thing of to-day. 
For example, a hundred years ago in the great 
Obstetric Hospital of Dublin the training of mid- 
wives, or monthly nurses, began ; this training 
occupied in the case of each pupil six months. 
These women, quoting the words of the late Dr. 
McClintock, are thoroughly taught the mode of 
conducting ordinary labors and the nursing re- 
quired by the mother and child during the puer- 
peral period. "The King and Queen's College of 
Physicians in Ireland have taken the lead in grant- 
ing a diploma to women of this class who pass an 
examination in midwifery, not including operations, 
and nurse-tending." I think that the Dublin plan 
is essentially right ; that is, the nurse's education 
ought to be such that she can safely conduct an 
ordinary case of labor; not that she should be a 


midwife, but have such familiarity with a midwife's 
duties that she will be properly prepared to meet 
common emergencies, which are sure to come now 
and then in her experience as an obstetric nurse. 

In the year 1832* the late Dr. Joseph Warring- 
ton of this city began training obstetric nurses; the 
time required for this instruction was one year. In 
all there have been taught in the institution founded 
by him, and which is still carrying on its beneficent 
work, between 1500 and 2000 nurses. 

The Training School for Nurses at the Woman's 
Hospital f was begun in 1863, but systematic teach- 
ing was not established until 1872. The course of 
instruction lasts two years. The School has had 
one hundred and fifty graduates, and now has forty- 
two pupils. 

Even in Philadelphia, where the training of ob- 
stetric nurses, as we have seen, was begun so long 
ago, I think there is a large majority of nurses who 
have had no hospital experience, and who have 
never been pupils in a training school. From the 
Directory for Nurses in connection with the College 
of Physicians I find that there are among the 
registered nurses 257 who have graduated at a 
training school and 274 who are non-graduates. It 

* I am indebted to Dr. Ellwood Wilson for this information, 
•j- Dr. Anna Broomall has kindly given me this information. 


is reasonable to suppose that in the entire number 
of non-registered nurses the proportion of those 
who have not graduated is still greater. 

I need not tell you that the time occupied in 
obstetric work by nurses in this hospital is three 
months. I wish that those who are to become 
exclusively obstetric nurses were given at least six 
months in such work, and that they were taught 
many things they are not, for example, obstetric 
auscultation and palpation, and also how to conduct 
an ordinary case of labor. 

Special Responsibility of the Obstetric Nurse. 
— It is generally admitted that the obstetrician has 
a greater responsibility than that of the physician 
or the surgeon, because he has the care of two lives. 
For the same reason the obstetric nurse has a 
heavier burden resting upon her than the medical 
or surgical nurse has. Furthermore, the lives that 
she cares for are peculiarly sacred, the one by the 
consecration of suffering, and the other by its 
utterly helpless condition, though at the beginning 
of independent existence. Labor is a drama which 
begins, continues and ends with pain; it is the 
highest function of the human body, and yet the 
only function invariably attended with suffering, 
the suffering in some instances the severest known 
to the race. Instinctively the nurse will desire to 
comfort the sufferer, giving relief if possible, and 


averting danger during and after the struggle. 
And when the great agony ends, how the babe's 
first cry — possibly thrilling the mother's heart with 
new joy, or arousing anxious forebodings — appeals 
for human sympathy and help ! Lucretius has thus 
spoken of the newborn child : " Then the infant, 
like a mariner tossed by raging seas upon the shore, 
destitute at his very birth of all supports of life, for 
the time when nature first presenting him to the 
day, fills the air with doleful cries, as foreseeing 
life's miseries." * 

More frequent than the ticking of the clock is 
the birth of a human being — seventy children born 
every minute. In the commonness and frequency 
of the event we may forget its sacredness and im- 
portance. Familiar as is the sight of mother and 
babe to many, no one should fail to think of the 
beauty and mystery that therein dwell. With truth- 
ful eloquence Charles Kingsley said " that phy- 
sicians and the wise men who look into the laws of 

* This passage suggests the following from Herodotus as to the 
conduct of the Thracians at birth and at burial : " The relations, 
seating themselves around one that is newly born, bew r ail him, de- 
ploring the many evils he must fulfill, since he has been born ; 
enumerating the various sufferings incident to mankind; but one 
that dies they bury in the earth, making merry and rejoicing, re- 
counting the many evils from which he has been released. He is 
now in perfect bliss." 


nature, of flesh and blood, say that the mystery is 
past their finding out; that if they could find the 
whole meaning of those two words, mother and 
child, they could get the key to the deepest wonders 
in the world; but they cannot. And philosophers, 
who look into the laws of soul and spirit, say the 
same. The wiser men are, the more they find in 
the soul of every newborn babe, and its kindred to 
its mother, wonders and puzzles past man's under- 

While our vision, then, may not penetrate this 
mystery, those who are brought oftenest and nearest 
to it ought to acknowledge its power. A clergy- 
man once observing that famous work of art, 
Murillo's picture of the Annunciation, said that it 
revealed the consecration of maternity, adding these 
words : " What Murillo meant to say I do not know, 
but what he has said is that through Mary, the 
mother of our blessed Lord, there came a blessing 
upon all babes, and infant faces are glad because she 
was the mother of our Redeemer." He also quotes 
the passage from Timothy, adopting the translation 
in the Revised Version, that woman shall be saved, 
not in, but by childbearing. Some perish in giving 
birth, but by this function blessing may come. 

Some years ago an eminent London surgeon, 
now dead, wrote a little volume entitled " The 
Mystery of Pain," and the burden of the book is 


that pain may be sacrifice for love's sake, leads to 
a higher development of character, and may fulfill 
an important purpose in the world's spiritual econ- 
omy. The mother's care of her child is exacting 
and wearisome, and requires the abandonment of 
many a pleasure — in a word, it is sacrifice, but 
sacrifice on the altar of love, and may lead to a 
higher life ; and thus pain exalts and purifies, and 
crowns with heavenly grace and beauty. 

I trust you will not think the time wasted in this 
endeavor to show the responsibility and dignity of 
your calling, and to impress upon your minds that 
lives whose chief end is the good of others are the 
noblest, and that even sacrifice is far better than 
selfish pleasure, and gives new beauty to character, 
new strength to virtue. Unless we love our fellow- 
beings, earnestly desire to lighten their sorrows, 
and lift from prostrate forms the cross of suffering, 
neither as nurses nor as doctors can we attain the 
best ideal of life. If we live simply and solely to 
sell our knowledge and skill at the highest price to 
sufferers, having no greater ambition than to make 
all the money we can, and in this spirit occupy 
places in the temple consecrated to healing the 
sick, we are no better than the money-changers and 
the dove-dealers in Jerusalem's temple, who fled its 
sacred walls affrighted at the stern rebuke of the 
Divine Master. 


The following passage from Ruskin, relating to 
doctors and nurses, may be appropriately quoted 
in this connection : " They like fees, no doubt 
ought to like them ; yet, if they are brave and well- 
educated, the entire object of their life is not fees. 
They, on the whole, desire to cure the sick ; and if 
they are good doctors or nurses, and the choice 
were fairly put to them, would rather cure their 
patient and lose their fee than kill him and get it. 
Their work is first, their fee second. But there is 
a vast class who are ill-educated, cowardly, and 
more or less stupid, and with these the fee is first 
and the work second. If your work is first and your 
fee second, work is your master, and the Lord of 
work, who is God. But if your fee is first and 
your work second, fee is your master, and the lord 
of fees, who is the ' least erected fiend that fell.' " 

The nurse's life is a private one, her work con- 
cealed from public observation, and her highest 
reward not such as most men and women regard 
the best. But nature's richest beauty and choicest 
blessings are often produced in silence and secrecy. 
The wild violet is hidden by the wayside or in the 
solitudes of the forest, and the purest, coolest foun- 
tains of water have their source in the deep dark- 
ness of the hills. And so it is that the human life 
richest in beauty and in blessing is rarely that 
which is most freely exposed to the public gaze, 


and is crowned with the world's glory and rewarded 
with the world's gold. 

Qualifications of the Obstetric Nurse. — Before 
speaking of the special fitness and requirements and 
duties of the obstetric nurse, allow me to quote from 
Dionis, a famous French accoucheur, whose work 
upon obstetrics was published at Paris in 171 8, 
some advice that he gives in a chapter upon the 
Choice of a Garde d' Accouche es. Some things will 
seem to you quite absurd, but most that he says is 
as valuable to-day as when it was first written. 

Dionis states that while the occupation of a 
garde does not seem very difficult, nevertheless, she 
needs some skill to do her work well. A young 
person ought not to engage in it, for she cannot 
inspire the necessary confidence. The garde should 
be in the vigor of life, and at least thirty years of 
age, so that she knows- something of the world ; 
she ought not to be so old that she cannot endure 
the fatigue of her occupation, nor watch the ac- 
couchee in the diseases which may occur. Her 
appearance ought to be pleasing, and she ought to 
have judgment and politeness, so that she can 
agreeably entertain the accouche e when alone with 
her, and do the honors in the visits that the latter 
receives, "of which she is the mistress of ceremonies. 
She must not be a tattler, telling all that happens 
in the family, especially anything that may be 


injurious to her patient. She must be faithful in 
the recital given the accoucheur or the physician 
of all that has occurred since his last visit, and in 
carrying out his directions ; for there are some 
gardes who have such a high opinion of themselves 
that they take the liberty of treating dccouckees in 
their own way ; and this is a great mistake, for 
many accouche es suffer, and are the victims of the 
nurse's ignorance. 

She must be temperate in eating and drinking, 
and above all avoid wine, because, sleeping too 
much, she will fail in the duty at regular hours she 
owes the accoucJiee. 

She ought to visit the pregnant woman some 
days before her labor, to ascertain if all the linens 
necessary for mother and child are provided, have 
everything ready for the travail, and be at hand to 
do whatever may be required, 

She must wash the child as soon as it is born, and 
dress it properly so that the clothing gives it no dis- 
comfort. She should stay awake with the child 
during the night until it has been baptized, lest some 
accident may happen to it before it has received the 
sacrament; she must exercise the greatest watchful- 
ness until it is placed in the hands of the wet-nurse. 

Her chief duties are to give the accoucJiee daily 
an enema made with a decoction of emollient herbs, 
to bathe the external parts, to remove the napkins 


as soon as they are soiled, and she must not let 
the bandages be too tight. She is to give food at 
regular hours, but must not let her patient talk too 
much, nor should she urge her to eat a great deal. 
She will not permit her to leave her bed until nine 
days, and, if possible, prevent her receiving visits 
until later ; she ought to prevent ladies who have 
perfumed powder, or who exhale any odor, from 
approaching the bed of the patient. When the 
accoucliec is able to go out, the garde accompanies 
her in her first visit, which is made to the church 
to render thanks to God. 

So much for the garde d'acconchees in the begin- 
ning of the last century. What ought she to be 
to-day, and what are her duties? 

It may be at once assumed that the obstetric 
nurse needs the same physical, mental and moral 
powers which are necessary for the nurse in general, 
and at first has the same training. Specialism in 
nursing, like specialism in medicine, has one foun- 
dation. The medical specialist lays the basis of his 
work in a general knowledge of medicine, and this 
knowledge ought to be practical as well as theo- 
retical ; so the specialist in nursing must first be 
thoroughly grounded in the general principles and 
practice of nursing. 

Remembering that her duties begin with woman 
in the latter part of pregnancy, a condition which 


exalts nervous sensibility, and which often causes 
in its subject great anxiety and grave apprehension, 
she ought to be, above all nurses, gifted with tact. 
So, too, this tact is constantly required in the 
lying-in room. Tact, which, etymologically, is 
simply touch, implies a delicacy, a quickness and 
accuracy of recognition of special conditions, as 
perfect as the record of atmospheric changes made 
by the barometer, of heat changes by the ther- 
mometer, of electric currents given by the galvan- 
ometer. When we were children did we not believe 
that cats could see in the dark ? When we were 
older we learned that the cat found its way so cer- 
tainly, so quickly and so safely in the thickest 
darkness not by sight but by touch ; that the pro- 
jecting hairs at the side of her face, her " whiskers," 
insensitive themselves, were at their origin in con- 
tact with sensitive nerves, and thus she was instantly 
told of contact with objects, and surely guided. 

But tact is not merely discovery, for after dis- 
covery comes direction, avoidance, obviating. The 
wise nurse will seek the patient's wishes and desires, 
and let them give guidance whenever they are con- 
sistent with true interests ; she accomplishes essen- 
tial ends by gentleness, by kindly and opportune 
counsel, not by ill-timed and coarse compulsion ; 
she seeks to lead rather than to drive, and while 
having the serpent's wisdom, likewise keeps the 


harmlessness of the dove, so that no offence is 
given. Learning the patient's sympathies and 
antipathies, she endeavors to have the former 
respected, and averts excitement of the latter. She 
may not, she is -not able, to scatter flowers upon 
the via dolorosa which every woman in the function 
of childbirth must walk, but her tact will teach her 
how to remove many a sharp thorn and bruising 
pebble which are in that way. 

May I add that the obstetric nurse should have 
a special fondness for her work, chosen voluntarily, 
pursued lovingly and hopefully. Coleridge has well 
said : 

" Work without hope draws nectar in a sieve, 
And hope without an object cannot live.*' 

Among the simplest and most beautiful utter- 
ances of Richter was, " I love God, and little chil- 
dren." And if the obstetric nurse can make the 
same avowal, she is in no wise less fitted for her 

Reasons for Giving Up an Engagement. — The 
nurse is usually engaged some months before the 
labor is expected to occur. But if at the time her 
services are needed she should be in attendance 
upon a case of puerperal fever the engagement must 
be given up. So, too, referring to those who com- 
bine other with monthly nursing, they ought not 
to go to a woman in or after labor if they have been 


nursing cases of scarlet fever, or of erysipelas, or of 
diphtheria, or patients having purulent discharges 
and suppurating wounds; the nurse coming, for 
example, from attendance upon a woman with 
cancer of the womb has more than once brought a 
fatal poison to the puerpera. Nevertheless, my 
faith in perfect cleanliness and antiseptics is so great 
that I believe the nurse or doctor may be com- 
pletely disinfected in a little time, without waiting 
for the weeks required for mechanical disinfection. 
Thus, an entire bath, during the taking of which a 
flesh-brush and soap are diligently used, and this 
followed by an antiseptic bath, e.g., one in which a 
one per cent, solution of creolin, or i to 10,000 of 
corrosive sublimate, is used, and then fresh clothing 
put on, will, I believe, render a person perfectly 
free from the possibility, or at least the probability, 
of conveying, even from a case of septicaemia, 
poison to the puerperal woman. Nevertheless, few 
physicians would consent to the employment of the 
nurse who had even recently had charge of any of 
the diseases mentioned ; and the nurse may well 
conform her action to the maxim of Zoroaster, so 
useful in questions of casuistry relating to many of 
life's emergencies, " In doubt whether an action is 
right or wrong, abstain." 

Another rule is here to be given : the clothing 
worn, the catheter, the thermometer, or any other 


instrument used while in attendance upon any of 
these diseases, must be disinfected before going to 
another patient, and especially to a woman in labor, 
or who has been recently delivered. 

After these remarks made in regard to the pre- 
cautions the nurse should use lest she transmit 
disease, let us consider the duties of the obstetric 
nurse. These may be conveniently divided into 
three classes. Duties before, during, and after labor. 

The Duties Before Labor. — The engagement 
of the obstetric nurse is frequently by the advice 
of the physician, often, too, by that of friends, and 
sometimes accidental, or emergency occurring the 
first nurse that can be had is employed — a sort of 
Hobson's choice. Now, it is important that the nurse 
should, upon visiting, attract and not repel her 
charge, that she should commend herself, not in direct 
words, but in general appearance and conduct; she 
ought to inspire confidence, and this she can best 
do when she has been best educated. Little things 
oftentimes tell the story of success or failure, and 
the following incident may have its moral. A nurse 
once came to me with very good recommendations ; 
she was a stranger, and needed work, and I pro- 
cured her an engagement. But when she called 
upon the prospective patient she was not neatly 
dressed, and had just eaten heartily of raw onions, 
and the engagement was cancelled. Poverty can 


rarely be the excuse of the nurse for want of proper 
personal apparel. One of the old English poets 
has said, 

" No spring or summer's beauty hath such grace 
As I have seen in one autumnal face." 

And thus, no matter how deficient one may be 
in nature's frail dower, fleeting, fading beauty, there 
is a beauty of soul that illumines plain features with 
growing grace, and gives them permanent attrac- 
tion and power. Pascal said if Cleopatra's nose had 
been half an inch shorter the condition of the en- 
tire world would have been changed ; but it may 
be doubted whether the length or shortness of the 
human nose determines success, or decides the ac- 
ceptance or rejection of a nurse. 

I wish it were possible for me to say that ability 
was always recognized and merit met its reward ; 
that brazen-faced assurance and impudent and lying 
self-assertion were always promptly rejected like 
spurious coin. Yet I believe, in the long run, truth 
and virtue will triumph, and all shams and frauds, 
blustering braggarts and self-seekers be cast aside. 
The empire of physical power, of ignorance and of 
error must become less as the reign of intellectual, 
moral and spiritual forces takes rightful possession ; 
the kingdom that is coming is not violence and 
coarse brutal power, but it is peace and love, gentle- 


ness and kindness, sympathy and succor, carrying 
hope and help to the suffering, and making sun- 
shine in all shady places. 

Let the nurse possess knowledge, and the power 
of readily applying it, let her be neat in dress, 
kind and polite in manner, honestly desiring the 
good of her charge and the honor of her profession, 
and she cannot fail, no matter what her deficiency 
in so-called personal attractions, in winning the con- 
fidence and esteem, if not the love, of all to whom 
she is nearest in the hour of woman's severest 
agony and sorest trial. 

Visiting the prospective mother, frequently, some 
weeks, or even a few months before labor, the 
nurse may give her much useful instruction and 
advice. If the latter is now pregnant for the first 
time, she will probably shrink from candid com- 
munication with her physician and frankly making 
known to him her various discomforts and suffer- 
ings, but will freely tell the nurse. This nurse 
ought to be so instructed in the hygiene of preg- 
nancy that she can give useful advice. As matter 
of incidental interest it may be stated that the first 
reference to such hygiene is found in the Bible, 
and consisted in abstinence from wine, which was 
enjoined upon the mother of Samson. The nurse 
can wisely counsel her charge as to suitable clothing, 
exercise, food and rest, if such counsel is needed. 


She will know that certain symptoms require the 
attendance of the physician. Thus, if the woman 
has bloody discharge from the womb, and pains, 
miscarriage or premature labor is threatened, the 
doctor must be at once called. Again, if there 
be notable swelling of the upper and lower limbs, 
and of the face, it may result from a watery con- 
dition with excess of blood — hydraemia and ple- 
thora, as technically known — and the greatest and 
promptest comfort comes from a hot bath, a glass of 
hot water being taken during the bath, so. that free 
sweating is caused. If the swelling referred to be 
associated with great paleness of the face, with 
disordered vision, possibly with severe pain, usually 
in the front part of the head, or great suffering at 
"the pit of the stomach," the patient has almost 
certainly albuminuria, and is in imminent danger 
of convulsions. In either case, and especially in 
the latter, the physician ought to be immediately 

The nurse, if the physician has not attended to 
this, and if the prospective mother is a primigravida, 
ought to know that the nipples are suitably de- 
veloped, and that proper means are used to prevent, 
where possible, their becoming injured by nursing, 
for fissured, excoriated or ulcerated nipples are the 
source of great distress, may require the mother to 
abandon furnishing her infant with the food that 


nature has prepared for it, or cause inflammation 
and abscess of the breast. 

While in some instances disease of the nipple 
cannot be averted, in most it can. In the former 
case the difficulty may arise from bad conformation 
of the organ, great delicacy of the skin, scanty 
supply of milk, so that the child in its eager and 
prolonged sucking subjects the nipple to special 
violence, and in other cases the injury may be 
caused by the child having what has been called 
"a murderous mouth." 

So far as the hygiene of the nipples in pregnancy 
is concerned, first, these organs must not be pressed 
upon by the clothing, but ample room given them 
to expand and develop under the stimulus of 
pregnancy. They must not be kept too warm ; 
indeed, some advise that each day they should be 
for a time uncovered, and thus exposed to the open 
air. Next, they must be kept clean, gently washed 
every day with a little soap and water, for other- 
wise the mammary secretion which occurs in preg- 
nancy will dry upon their summits, forming crusts 
beneath which the skin becomes tender, if not raw. 
If they are sunken and retracted, in some cases 
gently drawing out each nipple with the thumb 
and finger for a few minutes, twice at least every 
day, may give them suitable shape. The means 
most commonly in use to prevent injuries of the 


nipple is the daily application of some astringent 
and alcoholic preparation. It is many years since, 
both on theoretical grounds and from observation, 
this treatment seemed to me wrong. It certainly 
does not appear rational that when nature has pro- 
vided a part with such a vast number of fat-glands 
as she has the nipple, we should by astringents 
endeavor to lessen that secretion, and by alcohol 
dissolve that which is furnished. Further, nature 
meant the skin of the nipple to be soft and pliable, 
not harsh and stiff, as astringent applications tend 
to make it. No, I very much prefer to the usual 
plan of treatment the bathing that has been men- 
tioned, possibly followed by the employment of 
some cologne and water, or tincture of arnica and 
water, but in all cases the application once a day of 
a small quantity of cocoa butter. 

The nurse may be consulted as to the room to 
be occupied during confinement. She will select 
that one which is best ventilated, and which will 
be the most quiet, and is least exposed to the noise 
of the. street or of the house; the air of the room 
ought to be free from possible poisoning by sewer 
gas, and therefore remote from the water-closet, 
and not have in it a standing wash-basin in use. 
She may see that the bed can be placed in such a 
situation that it will be free from draughts, and can 
be accessible on either side. The room should be 


thoroughly cleaned, all accumulation of old clothes 
in closets or hanging on the walls removed, and the 
articles of furniture only those that are really neces- 
sary. The bedstead might well be washed, and all 
the bedding perfectly clean, and free from any 
possible contamination by disease-germs. 

Many women suffer more or less from despon- 
dency in the last weeks of pregnancy ; and when I 
think of the pains and the perils which belong to 
childbirth I often wonder that this despondency is 
not more general and more profound. But those 
perils are in almost all , cases only shadows, not 
realities, and in the exceptional instances in which 
they do come, professional skill can generally avert 
them, while the physical suffering may in almost 
every case be mitigated so as to be quite endurable, 
by the judicious use of an anaesthetic. The nurse 
can from her own observation speak words of en- 
couragement and hope, and by such kindly and 
wise utterances do much to dissipate the dark cloud 
of gloom, almost deepening at times into black 
despair, and be an inspiration of faith, hope and 
patience to those who are cast down. 

Expression of Opinions as to Doctors. — 
Questions as to the merits, absolute or relative, 
of different doctors are likely at one time or another 
to be presented the nurse. She may, probably will, 
have her preferences and deferences, her attractions 


and aversions, her likes and dislikes, though the 
latter may have no better foundation in reason than 
is indicated in the familiar lines as to " Doctor 
Fell." She must beware, however, of uttering a 
single word that will weaken the faith of her charge 
in the chosen medical attendant, and must never 
become a partisan, advising ladies to employ this 
or that physician. It is possible some doctors 
have sought to obtain practice by employing the 
tongues of nurses, these nurses in turn being re- 
commended by the doctors, and thus a concealed 
though not silent partnership existing between 
them. But this is a poor way for either doctor or 
nurse, and sooner or later brings both to grief unless 
they have superior abilities. 

The nurse must be careful not by word or act to 
condemn, or seem to condemn or censure a phy- 
sician ; here, if anywhere, silence is golden. I have 
seen so much of the fallibility of human judgment, 
and especially of hastily formed opinions, and 
knowing how liable we are to misunderstand 
human character and misinterpret human action, 
it seems to me one has excellent reasons for 
abstaining from great positiveness of conclusion 
and great frankness of speech. The nurse is just 
as fallible as any other person of like endowments, 
education, age and environments ; the very favor- 
able opinion she has of one doctor, and its opposite 


of another, may be simply the results of blind 
partiality and of equally blind prejudice, and it is 
possible that a longer experience and a larger 
knowledge might lead her to a complete reversal 
of those opinions. 

Criticisms of Other Nurses. — The nurse, too, 
will be wise who abstains from any criticism of 
other nurses; an ascent attained by treading upon 
others is very perilous, and the position thus secured 
is not likely to be permanent. On the contrary, let 
her defend, if defence be needed, and the oppor- 
tunity offers, the reputation of a sister nurse; possi- 
bly the minds of the assailants maybe so prejudiced 
that no light of truth can penetrate them, and then 
let her wait until the clouds roll by, lest her fate be 
that of those who cast pearls before swine. 

Position in the Family, of the Nurse. — In 
some families the nurse will hardly know whether 
she is fish, flesh or fowl, and the families them- 
selves will labor under the same distressing ignor- 
ance. Some regard her as a friend in need, and 
treat her with the utmost kindness and courtesy; 
others think her a sort of higher domestic, sub- 
ject to their orders, instead of having an empire 
of her own, obeying only the directions of the 
physician. Some will expect her temporarily to 
take charge of the house, look after domestic 
matters, possibly even spend odd minutes in the 


refreshing labors of a seamstress. Some will have 
her eat with the family, or at the family table, and 
others consign her to the kitchen, though Punch 
says " Gamps and Prigs never demeaned themselves 
by taking their meals in the kitchen." If the nurse 
does not receive the considerate treatment to which 
she is entitled, the failure oftener arises from igno- 
rance than from intelligent purpose. There are 
many kinds of people and of places in our world, 
and the nurse ought to be one of the most flexible 
of characters in order to adapt herself to the various 
conditions in which she is placed. Let her be con- 
ciliating and kind, not obsequious and sycophantic ; 
let her by her own dignity of character and just 
conduct secure not only the respectful, but con- 
siderate treatment to which her office entitles her. 
She will refuse burdens and cares that do not 
justly belong to her, unless some emergency re- 
quires her to bear them, or her own kindness of 
heart dictates she should. 

Silence as to Family Affairs. — The nurse ought 
to know the value of silence, so that the affairs of 
the lying-in room never become by word of hers 
the talk of the kitchen or of the neighborhood. 
Nay, more, let her seek no knowledge of family 
affairs, but let her rather refuse it, so that ignorance, 
if no higher influence, may secure her silence in 
regard to possible family discords and unhappiness 


It would be a blessed thing if all households were 
pictures of paradise, where peace and love reigned 
supreme. But sometimes there is a skeleton in the 
house, and if ever the concealing closet is opened 
to the nurse, that revelation ought to be a perpetual 
secret. There is an Eastern tale to the effect that 
a man, leaving the palace one day, was asked, 
" How does the Sultan?" and immediately replied, 
" The Sultan sleeps." " In one hour from that 
time the rash informer was exiled from Turkey, 
and told he had just escaped the bowstring, because 
he had dared to tell the secrets of the Sultan's 
palace to the world." 

Visits of the Clergy to the Sick. — There is 
one other important matter relating to the moral 
conduct of the nurse, occurring, however, only ex- 
ceptionally, still more exceptionally prior to labor, 
belonging, too, not exclusively to the obstetric, 
but also to the medical and surgical nurse, upon 
which a word ought to be said. Now and again 
the patient will be in imminent peril, or even 
death be inevitable. The question may be asked 
by her, or by her friends, as to having the spiritual 
adviser called. This question is usually addressed 
to, and answered by the physician, but sometimes 
the nurse's advice will be asked, or she may have 
the decision resting solely upon her. What is to 
be her answer ? Speaking from my own observa- 


tion, both of Protestant and of Catholic clergymen, 
I believe no evil comes, but rather blessing-, from 
the kind counsel and fervent prayers of a wise 
spiritual adviser; often a sweet calm, a peaceful 
resignation and a sublime trust are born of these 
ministries. God forbid that any of us, sheltering 
behind the common excuse that such visit will 
make the patient " nervous," " excite her too 
much," thus injuring her bodily state, should dare 
to run the risk of interposing, possibly, at some 
time, between an immortal soul and eternal happi- 

Premonitions of Labor. — Resuming the con- 
sideration of the duties of the nurse prior to labor, 
she ought to be able to tell the patient, if the physi- 
cian has not done this, the symptoms which herald 
the coming of labor. Among these are change of 
form of the abdomen, swelling of the external 
organs with increased mucous discharge, greater 
irritability of the bladder, possibly of the rectum, 
too, and probably there will be some noted restless- 
ness and nervousness; these last, just as certain 
atmospheric conditions precede the summer storm 
and predict its advent, are observed in many of our 
domestic animals when parturition is at hand. 

A change in the abdominal form, variously called 
" falling of the abdomen," "settling of the womb," 


etc., occurs in the majority of primigravidae some 
days, usually about two weeks before labor begins. 
This change is caused by the descent of that part 
of the child which is in the lower part of the uterus 
into the pelvic cavity ; it is the head of the child, 
still enclosed of course within the uterus, which 
thus descends. The fact is favorable, for it is then 
known that the presentation, that which comes first 
in labor, is favorable, and that the pelvic cavity is 
sufficiently capacious. The cause of the descent is 
the resistance of the abdominal muscles and other 
tissues of the abdominal wall to any more stretch- 
ing ; but the ovum, that is the foetal sac and con- 
tents, including of course the foetus, which is the 
most important part, requires more room, and finds 
it by the lower portion of the uterus enclosing the 
foetal head being pressed into the pelvic cavity, this 
pressure being exerted partly by the abdominal 
muscles, and partly by uterine contractions. The 
change referred to frequently occurs in the night, 
without the patient being conscious of the time or 
fact of occurrence ; but when she rises in the 
morning she finds the upper, portion of the womb 
lower than when she retired, and that it projects 
also farther in front, and her waist is smaller; there 
is less pressure upon the stomach, so that possibly 
she takes a larger quantity of food at one meal than 
she did, and the descent of the diaphragm being less 


opposed, she can fill her lungs more completely, 
take a deeper inspiration than before. But while 
her stomach and chest are thus notably relieved, it 
is probable other discomforts arise; thus the greater 
forward pressure of the body of the womb, and the 
pelvic pressure of the lower portion of this organ 
may cause irritability of the bladder, so that she 
is compelled to urinate more frequently; in some 
cases pressure upon the rectum is so great that 
frequent desire to evacuate it annoys her ; finally, 
the swelling and softening of the pelvic joints 
belonging to pregnancy may now be so increased 
that walking is rendered difficult. 

The change in the abdominal form thus described 
does not usually occur in women who have pre- 
viously borne children, because the relaxation of the 
abdominal wall is so great that the descent of the 
presenting part into the pelvic cavity is not com- 
pelled, but there is ample abdominal room for the 
development of the ovum. Xor does it invariably 
occur in those who are pregnant for the first time. 
Finally, this event may not happen until a few 
days, or even only a few hours before the beginning 
of labor. 

In some instances, however, labor begins with- 
out premonitory symptoms, or at least these are 
not observed. Thus there may be premature rup- 


ture of the amnial sac, cither from accidental 
violence or because of preternatural thinness of 
the walls, or from excessive distention, and, follow- 
ing upon the escape of the amnial fluid, regular 
uterine contractions set in ; in other instances the 
pregnant woman goes to bed feeling quite well, but 
is wakened in the night from sound sleep by " the 
pains " of childbirth. 

Whenever uterine contractions are regular in 
recurrence, attended with suffering, the intervals 
which separate them gradually becoming shorter, 
and the distress increasing — especially, too, if 
there is an augmented discharge of mucus, still 
more if that mucus be stained with blood, thus 
making what is commonly known in the lying-in 
room as " a show " — labor has begun. 

Preparation for Labor. — An entire bath, the 
water warm, and soap freely used, ought to be taken 
at the beginning of labor, and the patient after 
coming out of the bath should have clean cloth- 
ing put on. This much she may do without 
the nurse's assistance, provided the nurse has not 
yet arrived. 

The nurse ought, by reading and observation, to 
know the physiological phenomena of labor, and 
especially those commonly included under the 
terms, the three stages of labor; and knowing 


them ought, if the patient has not been informed 
by her physician, or is without previous experi- 
ence in childbirth, explain them to her. In the 
first or the uterine period of labor, dilatation of 
the mouth of the womb is accomplished, so that 
the presenting part of the child can escape from 
the womb. It is much longer than both the other 
stages or periods ; although not giving rise to such 
intense suffering as the second period, it is more 
trying, wearies, worries, and seems to the inexpe- 
rienced sufferer useless and vain; no voluntary 
effort on her part can assist or hasten the process, 
and such effort, too often advised by ignorant 
friends under the misguiding words to " do all she 
can to help herself," causes her to spend her 
strength for naught, and exhausts force which she 
will need by-and by for the real agony, for the 
strong struggle of labor. In the second period 
abdominal contractions assist the action of the 
uterus, and it ends in the complete delivery of the 
child ; in this period voluntary effort, wisely made, 
is of great moment. The third period consists of 
the expulsion of the after-birth and membranes, an 
event usually accomplished within thirty minutes 
after the birth of the child. 

The information which the intelligent nurse thus 
gives her charge will be most useful, help to take 


away her fears and prevent her mistakes. A path- 
way upon which the light of knowledge shines 
ceases to be invested with imaginary dangers and 

The nurse's duties during and after labor will be 
considered in the next lecture. 


Sepsis, Antisepsis, Septicaemia. — The glory 
of recent obstetrics is, not the axis-traction force] 
and neither Porro's, nor the " improved " Cesarean 
operation. Greater than any, greater than all of 
these in beneficent results is the discovery that by 
asepsis and antisepsis an almost absolute immunity 
from dangerous disease can be secured to women 
in childbed. The three names which are to be 
held in most distinction for their contributions to 
this important knowledge are Semmehveis, Pas- 
teur, and Lister. 

Once, and that not so long since they ceased, 
there were frequent fearful so-called epidemics of 
puerperal fever which decimated maternities, or even 
swept away more than one in ten of their inmates. 
It not unseldom happened that the unknown 
"puerperal poison" accompanied the doctor, the 
nurse, or the midwife in their private practice, and 
death, whom they did not see, walked by their 
side, and worked through their instrumentality. 
Now this awful disease is gradually becoming rare, 
as it once was frequent ; the mortality in well-con- 
ducted maternities, though these may be used for 
clinical teaching, has fallen to about one-half of one 



percent; the temperature of the puerpera rarely 
becomes febrile, or this elevation is very brief — in 
a word, not only mortality, but also morbidity, has 
been marvellously lessened by the faithful and 
intelligent use of aseptic precautions, and of anti- 
septic means. And the day is surely coming, if 
not already present, when the occurrence of septi- 
caemia in the puerpera will lead to the question : 
Who hath sinned, the doctor, or the nurse, that 
this woman is in peril, or perishes? Certainly 
there will be now and then a case of the disease, in 
regard to which careful and conscientious scrutiny 
of the entire history will fail to discover fault, sin 
of omission or of commission ; but this will be 
altogether exceptional. 

In this lecture upon your duties during and after 
labor, no words of greater importance can be 
spoken than asepsis, antisepsis, and septicaemia. 
Let us first understand what the words mean. 
Septicaemia was introduced into medical language 
by a distinguished French physician, Piorry ; it is 
derived from two Greek words, <rrj7zu>, to make 
rotten or putrid, <rr t --v/.i>*, making rotten or putre- 
fying, and difia, the blood. By it he designated 
all changes in the blood from septic or putrid 
matter, without reference to the source of this 
matter, or the medium by which it entered. The 
nature of the infecting agent is not certainly known. 


It has been called sepsine, but even Bergmann who 
upheld this view, admits that sepsine is the product 
of minute organisms called microbes; the creed 
most generally accepted is that without these 
organisms infection is impossible. They are at the 
limits of the vegetable and animal kingdom ; a 
microbe is a single cell, has a globular or elongated 
form, straight or sinuous, and reproduces in most 
instances by transverse division, sometimes by 
germinative cells, or endogenous spores. The 
rapid multiplication of microbes is remarkable. 
Cohn has determined by accurate calculation that a 
coccus, a name given to several forms of microbes, 
meaning simply a cell, requiring an hour to divide 
into two, at the end of three days has become three 

It is against this host of the almost infinitely 
small, and absolutely innumerable, characterized 
by such rapidity of reproduction, the obstetrician 
and the obstetric nurse must contend, guarding 
against their entrance into the body of the puerpera 
through the wounds which labor makes upon the 
inner surface of the uterus and in the birth-canal. 
If, notwithstanding all precautions, they do gain 
access, then the battle for life can only succeed by 
sustaining the unfortunate patient until they are 
eliminated or destroyed, and preventing their re- 


inforcement by the entrance of fresh germs, or 
chemical products of their action. 

Asepsis excludes, or endeavors to exclude, the 
germs of septic infection by means of perfect clean- 
liness — no infectious matter upon the person or 
upon her clothing, none upon the hands of nurse 
or of doctor, or upon anything brought in contact 
with her : soap and water are the most important 
agents of asepsis. Antisepsis directly kills dis- 
ease germs, and the agents doing this are often 
called germicides ; asepsis is the wall, the guard, 
the garrison ; antisepsis the army destroying the 
enemy ; the one defends, the other annihilates. 

While asepsis is essential in obstetrics, antisepsis 
cannot be neglected. Doubtless, if the former were 
always perfect, the latter might be disregarded ; 
but complete asepsis is not always, if ever, possible 
in obstetrics, and therefore antiseptic means ought 
to be employed. 

Excellent, intelligent, and conscientious practi- 
tioners will tell of their having attended hundreds 
of labors without having seen a single case of puer- 
peral fever, and yet they have not used antiseptics. 
Remember this is a mere negative argument, and 
therefore has less weight than it appears to have. 
There are many practitioners equally well qualified, 
and of equal experience with those referred to, who 


have not had such immunity from puerperal fever 
among their clients ; possibly, too, their own im- 
munity may suddenly end, and their very next 
cases of confinement be infected. When the won- 
derful results obtained by the use of antiseptics in 
lying-in hospitals are so well established, and so 
well known, the obstetrician who condemns anti- 
septic midwifery, even though it be only indirectly 
or tacitly, while not sure to escape puerperal mor- 
bidity and mortality from septic infection in his 
own practice, is very sure to contribute to that 
morbidity and mortality in the practice of others. 

Asepsis and Antisepsis in Practice. — So far as 
the duties of the obstetric nurse in protecting her 
patient from infection are concerned, reference has 
already been made to the employment of a bath 
and clean clothing at the beginning of labor ; during 
this bath a thorough washing must be given with 
soap, and let it be followed by the free application 
of an antiseptic solution* to the external organs of 
generation. If the woman, during the latter part 
of her pregnancy, has had much leucorrhcea, es- 
pecially if this has had, still has, an offensive odor, 
a free vaginal injection of a similar solution would 
be wisely used. Of course, the nurse is scrupu- 
lously cleanly, especially as to her hands, following 

* See Appendix. 


the Pharisaic practice of washing oft, and makes 
diligent use not only of soap, water, and nail-brush, 
but also of an antiseptic. But what shall the anti- 
septic be ? The selection of those who believe in 
antiseptic obstetrics is usually carbolic acid, or cor- 
rosive sublimate, or both, the former being used 
more especially for the disinfection of instruments. 
Dr. Bernardy, of this city, has especially demon- 
strated the value of the biniodide of mercury, and 
urged it as a substitute for the corrosive chloride. 
I think it probable that creolin is preferable to any 
other antiseptic in obstetrics ; it has a less un- 
pleasant odor than carbolic acid, even if it be not 
positively agreeable. It does not, like the anti- 
septics that are generally used, make with water a 
colorless, but a milk-like solution ; the drug there- 
fore testifies both by odor and by color as to its 
presence, and hence a double protection against 
mistaking the solution. Finally, it is claimed to 
have four times the germicidal power of carbolic 
acid, and, using creolin, it is unnecessary to have 
two antiseptics, one for hands and the other for 

The strength of the solution ordinarily employed 
will be one teaspoonful of creolin to a pint of water, 
that is, somewhat less than two per cent. 

Condition of Bowels and Bladder. — Even 
though the patient's bowels have been recently 


evacuated, it is better that she should have an 
enema of water, or of soap and water, so that they 
may be thoroughly washed out. Attention to the 
condition of the bladder should be given ; if not 
freely evacuated spontaneously the catheter must 
be used. This instrument ought to be well cleaned, 
before and after its use, and in the intervals of non- 
use has been directed to be kept in an antiseptic 
solution.* It would be better for the patient not 
to go to the water-closet during the first stage of 
labor, and certainly she must not be permitted to 
do this in the second stage, especially near its 

The nurse should so arrange the patient's hair that 
it will require little attention the fir.^t few days 
after labor. 

Food and Drink. — A woman in labor, unless 
this be protracted, rarely needs or desires food; 
nevertheless, if she is hungry, any simple, easily 
digested articles may be given in moderate quan- 
tity — it is better that she should take a small 
quantity of food at a time, and at short interva 
than much at once. Thirst is usually great, an 
the most refreshing drink will be cold water; 
hot and stimulating drinks are, as a rule, positively 
forbidden in normal labor. Nausea and vomiting 



occasionally occur in the first stage of labor, more 
especially near its close ; this irritability of the 
stomach, unless associated with exhaustion, is not 
regarded as unfavorable, and indeed a common 
saying is that " sick labors are quick labors," in 
that greater relaxation of resisting parts is thought 
to result from the sickness. 

Position in First Stage of Labor. — Usually it 
is not advisable for a woman to go to bed in the 
first stage of labor; a vertical, instead of a hori- 
zontal position of the body favors the descent of 
the child's head into the pelvic cavity, in case it 
has not already occurred. Nevertheless, if she be 
weak, or if hemorrhage occurs, the patient should 
be recumbent. So, too, toward the close of the 
first stage of labor, when the membranes usually 
rupture, it would be better for her to be lying 
down, for, standing or sitting at this time, gravity 
may invite such a sudden copious discharge of the 
amnial liquor that the flood possibly will carry 
down a part of the cord or one of the members, 
and thus the labor become complicated more or 
less seriously. 

Premature Discharge of "the Waters." — If 
the amnial liquor is discharged early in, or before 
the beginning of labor, the labor is said to be " a 
dry" one, and usually it is then longer and more 
painful, so far as the first stage is concerned, for the 


bag of waters, being entire, presses uniformly upon 
the mouth of the womb, mechanically causes com- 
mon dilatation of all parts of the circle, and by this 
uniform pressure evokes stronger uterine action. 
Moreover, the part of the foetus coming first 
cannot press equally upon all parts, and the 
pressure irregularly distributed is doubtless more 

. Preparation of the Bed. — The preparation of 
the patient's bed is made by the nurse. The bed 
ought not to be of feathers nor of straw; * neverthe- 
less, in some instances it may be necessary to use 
one or the other of these, and the nurse will first 
make it perfectly smooth and its contents evenly 
distributed, taking away all the hills and hollows. 
A mattress is much preferable. But upon bed or 
mattress let there be now placed a piece of rubber 
cloth or rubber; this occupies the middle third of 
the bed, thus extending well above where the pa- 
tient's hips will rest; it ought to reach over the edge 
of the bed upon that side on which the patient will 
lie. Immediately above the rubber a blanket and 
then a sheet, each folded twice, are placed. There 
are now two ways of continuing the preparation 
of the bed, one of which may be called the old, 
the other the new; the former will be first de- 

* See Appendix. 


scribed. The under sheet is spread upon the 
bed, and then immediately above where the hips 
will rest, folded transversely ; the lower fold is 
thrown over the upper, so that the entire sheet is 
placed so that it will not become soiled or wet 
during labor; delivery being completed, and the 
external organs properly cleansed, washed, and an 
antiseptic solution used, the folded half is drawn 
down under the patient and to the foot of the bed. 
The method, however, now generally employed is, 
after the rubber has been put in place, the under 
sheet covers it completely and occupies its usual 
position. Then a second piece of rubber is put 
over it, and above this a folded blanket or sheet, or 
both ; all these are removed after the labor ends. 
It is not uncommon to fasten a sheet folded diago- 
nally, or a roller towel, to the bed-post nearest the 
patient's feet, and she uses this to pull upon during 
" a pain." Instead of blanket and sheet, suitably 
folded, to receive the discharges from the uterus — 
amnial fluid, blood, etc. — in some parts of the 
country a sack of fresh bran is used for this pur- 
pose, and the practice is not to be condemned. 

The Patient's Clothing. — The patient's clothing 
will usually be stockings, chemise and night-dress, 
and a wrapper worn while she is up ; the chemise 
and night-dress must, when she goes to bed, be 
drawn up to her waist, so that they are saved from 


all soiling and wetting ; after the labor these gar- 
ments are replaced. Moreover, there will be pinned 
around her hips a suitably folded sheet; this is 
much preferable to the flannel skirt, or any other 
petticoat that one sometimes finds in use at this 
time, for such a garment, requiring in its removal 
to be drawn down the entire length of the lower 
limbs, must soil them, while the sheet, once un- 
pinned, can be immediately removed without such 
accident occurring. 

Obstetric Examination. — The nurse will ex- 
plain to the patient, if a primipara, the necessity for 
an " examination " by the physician, and at the 
proper time place her in suitable position, on her 
side or upon her back, the lower limbs being drawn 
up ; the side position will probably be preferred by 
the patient, but in many instances the physician 
will wish her afterward to turn upon her back, for 
several reasons, the chief of which is that often, 
while using one or two fingers of one hand in the 
internal examination, he desires to use the other 
hand for external examination to confirm or to 
assist the other exploration. 

The nurse has ready for the physician soap, warm 
water, nail-brush and towel ; after thorough use of 
the soap, water and brush, he washes his hands 
in an antiseptic solution, one part of corrosive 
sublimate to 2000 of water, for example, or a solu- 


tion of creolin, one teaspoonful to a pint of water. 
It is also usual to have some antiseptic ointment, 
with which he anoints the examining finger or 
fingers, carbolized cosmoline, for example ; but if, 
without drying the hand, it is used immediately 
after being dipped in an antiseptic solution, especially 
that of creolin, no ointment is needed, if the prac- 
titioner would only always so believe. 

Scissors and Cord. — The nurse is allowed that 
which is denied to most women nowadays, at least 
when clad in fashionable attire — an accessible and 
useful pocket. How often such women have to 
walk the streets holding in front of them that which 
seems their earthly treasure, the pocket-book, a 
pocket-book now, because it is never carried in the 
pocket ! How changed from that object which fable 
tells the cruel Constantine saw upon the sky, a repre- 
sentation of the Cross, beneath which was the legend, 
/;/ hoc signo vinces. The object is indeed changed 
in the case of these women ; now it is cash instead 
of cross, and the legend which one might justly 
imagine should belong to the public display of this 
emblem of power would be, /// hoc signo vinco, — "In 
this sign I conquer." If I urge the importance of 
the pocket, it is but an echo of Southey's belief, 
who said, "Now, of all the inventions of the tailor, 
who is, of all artists, the most inventive, I hold the 
pocket to be the most commodious, and. saving the 

" receiver/' bandage, etc. 63 

fig-leaf, the most indispensable." Well, the nurse 
generally has in her dress, and apron, pockets, 
not a single mere minimum receptacle so-called, 
remote and retired, which is sometimes crowded 
with a pocket-handkerchief, but pockets that are 
readily accessible and capacious, and therefore use- 
ful. Among the professional articles which may 
well find place in her pocket will be scissors, better 
that the ends of the blades be blunt, and material 
for tying the umbilical cord. While silk braid, 
twisted silk or hemp thread, tape, etc., are used for 
ligating the cord, I believe the best is Chinese silk, 
such as is used for tying the pedicle in an ovari- 
otomy, or after the removal of the uterine appen- 
dages ; with this the knot can be readily tied so as 
to thoroughly constrict the vessels of the cord. 
There is no danger of the silk cutting through the 
cord, nor of its cutting the fingers of the physician 
when he is tying the knot. 

" Receiver," Bandage, etc. — The nurse has a 
" receiver " ready; it is usually a small blanket, or 
it may be a shawl or a flannel skirt, made warm as 
the time of birth approaches. She also sees that a 
bandage for the mother, safety pins, needle and 
thread, towels, napkins, and whatever she may 
need in washing the baby, such as basin or small 
bath, soft rags, soap, etc., whatever she needs in 
dressing it and in caring for the stump of the cord, 


and hot and cold water, are at hand, or can be 
instantly had. 

Temperature of Room. Bed-covering. — She 
will observe the temperature of the room, which in 
winter ought to be about 70 . The patient will 
need but little covering when in bed, for her tem- 
perature is somewhat greater than normal as a 
result of the labor ; bluntly expressing a truth, there 
is vastly more danger of a woman taking dirt than 
of "taking cold" during labor. A single sheet, a 
blanket and a counterpane, will probably be all she 
really needs or will consent to have, even in cold 

Encouraging the Patient, and Exclusion of 
Persons not Needed. — The nurse, by a cheerful 
countenance and kind words, will encourage her 
patient. Though some women prefer silence dur- 
ing their labor, yet with the most at least occasional 
cheerful conversation will do something towards 
momentarily diverting their minds from thoughts 
of suffering. The conversation, if any be had, must 
be cheerful, not doleful ; rainbows do not reveal 
themselves in the room of travail ; but at least let 
no raven voice be heard there. This room is not 
an exhibition hall, and therefore only those actually 
needed and desired by the sufferer should be per- 
mitted in it; the nurse, knowing the sympathies 
and antipathies of her patient better than any one 


else does, can best regulate this matter. Some 
women desire their husbands to be present, while 
others, for the time, would prefer that they were in 
Jupiter, or some other remote part of the universe. 
There are, too, husbands who ought to be excluded, 
some few because of their utter heartlessness, more 
because of their unconcealed strong sympathy and 
great anxiety, thus unintentionally adding to the 
wife's suffering and fear, and still a few who em- 
barrass the nurse or doctor by unasked, unneeded 

Duration of Labor. — The patient will sometimes 
anxiously ask, when the labor will end? In 
general the travail of a primipara is from twelve 
to sixteen hours, though it may be prolonged to 
twenty-four, sometimes even be still longer, without 
risk to mother or child ; if the patient has pre- 
viously and recently borne a child, the time of 
labor is six to eight hours. The first stage is 
usually twice as long as the combined second and 
third. The nurse must beware of attempting the 
role of a prophet, and giving positive answer to the 
question; for her desire and sympathy will lead 
her to prophesy smooth things, making an en- 
couraging promise as to the speedy end of the 
suffering, and when the promise is not fulfilled, the 
poor patient is liable to lose heart and hope, confi- 
dence and courage. It is always better when we 


are ignorant to confess our ignorance than to 
assume knowledge ; a lie is a monstrous thing, and 
lying to the sick or the dying is a great crime, no 
matter who commits it. We walk in the darkness, 
darkness so thick that we may not be able to see 
the milestones, or the distant light that waits to 
welcome us ; only let us know that we are in the 
right road, then we also know every. step brings us 
nearer home. In like manner of the parturient, 
and so we may tell her. This much, however, is 
known even to the unprofessional observer; the 
final pains, so strong and frequent, tell that the 
agony is nearly over, victory, concluding and 
crowning the strife, is at hand. 

Suffering of Labor. Use of Anaesthetics. — 
Undoubtedly the suffering of labor is in the majority 
of cases great, very great. Yet pain, physical or 
mental, is an imponderable and an immeasurable : 
we have no means of knowing its relative or ab- 
solute severity. As the heart knoweth its own 
bitterness, so each woman knows her own suffer- 
ings in childbirth. The sensibility to pain, and the 
power of enduring it depend upon original organi- 
zation, habit, and energy of will. The Stoics, said 
the wise man, can be happy in the bull of Phalaris, 
a brazen bull heated to the fierceness of furnace 
heat. Plutarch, telling of the Lacedaemonian boys 
who were taught to steal, but also to conceal their 


theft, added : " So seriously did the Lacedaemonian 
children go about their stealing", that a youth, 
having stolen a young fox, and hid it under his 
coat, suffered it to tear his very bowels with its 
teeth and claws, and died upon the place rather 
than let it be seen." Hardly a man in these days 
would in silence submit to the one ordeal, hardly 
a boy to the other. You have read the story of 
that heroic Roman wife who gave no whisper of a 
groan in all the suffering of labor lest she might 
reveal the place of her husband's concealment, her 
love for him was so great. Montaigne has spoken 
of her as "that fair and noble wife of Sabinus, a 
patrician of Rome, for another's interest, alone, 
without help, without crying out, or so much as a 
groan, endured the bearing of twins." 

Let us not conclude from this incident that all 
women who bear children could, if they would, 
suffer in silence : we would also be equally far from 
the truth, were we to believe that severity of suffer- 
ing is indicated by the degree of manifestation in 
expression, in movement, in groan and clamor. 
Though the pain of childbirth is physiological, this 
the only function of the body the exercise of which 
causes suffering, it does not follow that no means 
should be used to mitigate it, and that it may not 
by its severity bring peril. In ancient Rome pros- 
pective mothers, during the feast of the Lupercalia, 


held out their hands to be rudely struck with 
leather lashes, thinking thereby the sufferings of 
childbirth would be prevented. Why mention 
all other vain means — such as the eagle stone 
fastened to the thigh, or feathers from an eagle's 
wing to the sole of the foot, anointing the um- 
bilicus with the fat of the viper or with the bile of 
an eel, placing upon the abdomen a calculus passed 
by some victim of stone, or the pulverized hoof of 
a donkey, or applying to the loins the nest of a 
swallow dissolved in oil, et cetera — that have been 
used in the vain search for means to lessen the pain 
of labor. It was not until the year 1847 tnat the ' ate 
Sir James Y. Simpson proved that sulphuric ether 
could be given by inhalation for the relief of the 
pains of childbirth, and the day of woman's partial 
redemption from primeval curse came. However, 
the administration of an anaesthetic in labor, is a 
question for the medical attendant, not for the 
nurse ; nevertheless, let me here say that I believe 
it is only in quite exceptional cases such relief 
cannot be wisely, safely, and usefully given. 

Position during Second Stage of Labor. At- 
tentions of the Nurse. — During the second stage 
of labor the patient is lying either upon her side, 
usually the left, or upon her back ; in this country 
the latter position is the more common. The side 
position lessens the liability to tearing the perineum, 


but if a woman is upon her back greater voluntary 
effort can be made, assisting uterine contraction, 
for then body and limbs are more certainly fixed, 
made rigid in position, and hence no force is lost by 
being transmitted through a flexible rod, and, more- 
over, and mainly, she can then take a fuller inspira- 
tion, thus depressing the diaphragm more and 
lessening the abdominal cavity, so that the con- 
traction of the abdominal muscles acts with more 
force upon the uterine contents. Hence, during at 
least the greater part of this stage of labor, the 
dorsal position is to be preferred ; towards its close, 
however, should perineal rupture be feared, let the 
patient be turned upon her side. Then the nurse 
places between the knees a small folded pillow or 
sheet rolled up, so as to secure separation of the 
thighs, which, by their approximation, would hin- 
der the escape of the child. 

Most women desire, during a pain, to press upon 
some firm resistance with their feet, and to pull 
with their hands, grasping something that does not 
yield ; this may be accomplished by having the 
sheet or towel fastened at the foot of the bed as 
I have mentioned, and interposing between the 
feet and the footboard a stool or a box. But a 
better way, I believe, is for two persons to sit facing 
the patient, one on each side ; she has the thighs 
slightly flexed, and the legs nearly at a right angle 


to them ; now when a pain comes let her grasp 
one of the hands of each assistant, while their other 
hands are applied to the front surface of her legs. 
These assistants are not to pull or to push, but 
simply resist her pulling and pushing. The patient 
is to be taught — for she must " learn to labor," 
oftentimes, too, " to wait " — that the longer she 
holds her breath during "a pain," the more effec- 
tive it will be, for, taking frequent inspirations, the 
force is injuriously divided, broken into fractions, 
which are then not as efficient as the unit they com- 
pose. Further, her body ought to have a fixed posi- 
tion at this time, the head well inclined to the chest. 

If a woman has finger rings that are at all tight, 
they should be removed at the beginning of labor, 
for the fingers inevitably swell, and hence injurious 
pressure may be caused by these ornaments. 

The nurse will have at hand cold water, if the 
patient is thirsty, as she generally is ; bathing her 
face from time to time with cool water is often 
grateful and refreshing to her. During the inter- 
vals between the pains the patient should be advised 
to rest as quietly as possible; peradventure she 
may get little snatches of sleep, saving and restoring 
strength. Indeed, one of the great blessings, as I 
believe, of obstetric anaesthesia is the usually fol- 
lowing perfect calm after uterine and voluntary 
action, though the anaesthetic is then withdrawn. 


The nurse, from time to time, removes wet and 
soiled napkins, replacing them by dry and clean 
ones ; such attentions comfort the patient in some 
degree, are one of the means of guarding her against 
infection, and are always appreciated by the doctor. 
Cramps in one of the lower limbs are not uncom- 
mon, and are best relieved by brisk rubbing the 
affected part and straightening the limb. When 
the child's head presses strongly upon the rectum, 
the patient may think she needs to have an evacua- 
tion, and will insist upon getting up for that pur- 
pose ; she may refrain voluntary effort from the 
fear that there may be a discharge from the bowels 
into the bed. But if the second stage is near its 
end her getting up is forbidden, and a bed-pan, or 
simply cloths, used ; very frequently the need is not 
real, but imaginary. 

Delivery of Child and Placenta by the Nurse, 
in the Absence of the Doctor. — Presuming the 
doctor to be present, he, of course, attends to all 
the details in delivering the child ; but if he has not 
arrived, then the nurse must take this duty. Sup- 
posing that the duration of the labor, the frequency 
and the force of uterine contractions and abdominal 
efforts, and the suffering of the patient, indicate the 
rapidly coming end, the nurse will have the woman 
turn upon her side — the reference is made to a 
primipara in whom danger of tearing the perineum 


is great — and finding that during "a pain " the peri- 
neum bulges outward, and that part of the head 
protrudes from the vulvar opening, receding when 
the pain ceases, she will now endeavor to guide the 
head, by pressure during a pain upon the perineum 
with one hand, and grasping the head with the 
other hand, in the axis of the vulvar ring, and even 
hold it back until that ring is sufficiently stretched 
to permit its escape without serious injury. The 
head emerging is received by her hand, in which 
it rests ; she immediately passes one or two fingers 
of the other hand to the neck of the child, to ascer- 
tain if it is encircled by the cord — such encircling 
may be once or more ; finding a loop round the 
child's neck, she at once, but without haste or vio- 
lence, draws upon the cord at that portion which 
yields more readily, until the loop is long enough 
to be slipped over the child's head ; if she cannot 
get so large a loop, it is only exceptionally that it 
will not go over the shoulders, which in a very few 
minutes follow the head. A new utero-abdominal 
effort occurs two or three minutes after the expul- 
sion of the head, and she finds the infant's head 
giving a quarter rotation, so that the face which 
looked toward the perineum — of course I am speak- 
ing of usual cases — now looks toward the inside of 
one or the other of the mother's thighs ; the shoul- 
ders are expelled almost immediately after, and the 


rest of the body soon follows. Let her not, unless 
some emergency compels instant delivery, draw the 
child out as soon as the chest is delivered, but leave 
its complete expulsion to nature. .As soon as the 
head is born, she should direct an intelligent assist- 
ant, if such be present, but better obedient ignor- 
ance than no help, to place a hand upon the patient's 
abdomen directly over the uterus ; the hand not 
flat, but the fingers slightly flexed upon the palm, 
so that a concave surface which will adapt itself to 
the convexity of the womb is made, and then by 
the hand thus placed follow down the uterus as it 
lessens in size with the complete expulsion of the 
child : a proper use of the hand at this time does 
much to secure firm uterine contraction. 

The infant when born should be placed upon its 
side near the edge of the bed, so that access of 
fresh air is obtained ; care must be taken that there 
is no stretching of the umbilical cord. In most 
cases the child breathes freely and cries vigor- 
ously; if it does not, simply striking the chest with 
the end of a towel or napkin wrung out of cold 
water, or dashing a few teaspoonfuls of cold water 
upon the chest, quick friction of the surface, or sud- 
denly changing the child's position, will usually be 
the only means required to insure free respiration. 
Ten minutes may thus pass, the circulation in the 
umbilical cord has ceased or become quite feeble 


and then the cord is to be tied, two ligatures being 
used, the first being placed two inches or less from 
the umbilicus, and the second an inch at least 
beyond the first; each ligature should be tied 
securely, especially the one nearest the child, and 
this can be very readily done with the Chinese silk 
that has been advised. 

After dividing the cord between the ligatures 
wipe away all blood from its foetal end, and watch 
for a minute to see if any oozes out, and if there 
does apply another ligature. The child is handed 
to an attendant and the nurse assumes the care of 
the mother. Placing her hand upon the woman's 
abdomen she feels very distinctly the contracted 
womb, and by its size and firmness she judges 
whether the placenta has been detached, and par- 
tially or completely expelled into the vagina; if 
the uterus makes a round, hard body just above 
the pubes, about the size and almost the hard- 
ness of a croquet ball, then it is almost certain 
the placenta is no longer within it. The placenta 
is, in the majority of cases, spontaneously expelled 
within twenty or thirty minutes after the delivery 
of the child, sometimes not more than ten or five 
minutes intervene. Of course, if the placenta be 
in the vagina, its removal is a very simple thing. 
But suppose that by the size and the want of 
rigid contraction of the uterus, and by there hav- 


ing been no " pains," the placenta be still in the 
uterus ; if there be no unusual flow of blood, wait, 
still, however, keeping the hand upon the uterus as 
a sentinel to warn if uterine relaxation occurs, and 
a messenger to inform of uterine contraction, and 
when either occurs, by suitable compression of the 
uterus endeavor to counteract the one and to as- 
sist the other. Until the placenta is expelled the 
sentinel hand is applied to the uterus through the 
abdominal wall, nor even then should it be removed 
if the uterus be not firmly contracted ; indeed, in 
all cases moderate manual compression of the 
womb may be wisely continued until the bandage 
is applied. 

If the delivery of the child took place with the 
patient on her side, she had better be turned on 
her back before the expulsion of the placenta. A 
single pillow or the bolster will raise her head suf- 
ficiently, and if she be at all faint, better remove 
even that, so that her head rests directly upon the 

Removal of Soiled Cloths, Bathing and Band- 
aging. — Supposing the last stage of labor, that is, 
the delivery of the placenta ended, the nurse's next 
duties are to remove soiled cloths, bathe the exter- 
nal sexual organs with a warm antiseptic solution, 
and wash out the vagina with a similar preparation 
— my preference for a solution of creolin, one tea- 


spoonful to a pint of water, has previously been 
stated. Sponges ought not to be used in this or 
subsequent washing of these parts, but old muslin 
or linen rags, or jute, and whatever material is used 
should afterward be burned. If the nurse dis- 
covers any tears, the physician's attention may be 
quietly called to the fact — most probably he will 
ask information upon this point, and desire to ex- 
amine the condition. 

The bandage is now to be applied. This is of 
firm material, unbleached muslin, for example ; it 
should be eighteen inches wide, and long enough 
to somewhat more than encircle the abdomen, so 
that it can be readily pinned. In applying it first 
roll up the bandage one-half its length, then carry 
this roll under the back, including the hips, when 
it is to be unrolled and made perfectly smooth, the 
ends crossing each other over the abdomen, and 
pinned — the pinning is usually directed to be begun 
below, but, as taught by Warrington, I think it 
best to begin above. Some place a napkin directly 
over the uterus, this napkin folded so as to make a 
compress, which is covered and kept in place by 
the bandage ; the compress is probably useless. An 
antiseptic napkin, or pad, is now applied over the 
vulva ; this is designed to absorb the discharge that 
comes from the uterus, and during the first twenty- 
four hours the flow being considerable, probably 


ten or twelve napkins will be required ; frequent 
changes are necessary for comfort, for cleanliness, 
and for safety. The chemise and night dress, and 
the folded half sheet, if this method of arranging 
the bed has been followed, are drawn down, and 
the patient given an opportunity to have that 
rest she so greatly needs. Nevertheless, some 
food may be taken before this rest, if she desires 
or needs it. 

Raising the Hips for Removal of Soiled Bed- 
clothes, etc. — I will illustrate with the obstetric 
phantom which has been brought before you to- 
day, a simple "method, so greatly needed, for raising 
the hips in the removal of soiled cloths, applying 
the bandage, arranging the clothing and the bed 
clothing under the patient. This method is avail- 
able in all cases unless the patient be of unusual 
weight. The patient is lying upon her back, the 
thighs moderately flexed and the legs nearly at a 
right angle to them ; the nurse, if she be strong 
enough, places one arm extended beneath the pa- 
tient's knees, and the other directly over the legs, 
and thus has perfect command over the lower 
limbs; she can now, without great difficulty, thus 
lift the hips high enough to make the changes that 
have been mentioned. 

Washing the Infant. — The mother's comfort 
having been secured, the nurse's attention is turned 


to the child. She places the infant, still wrapped 
in "the receiver," upon her lap, which is protected 
by having first put upon it a flannel apron or small 
folded blanket. She has at hand a cup of cool 
water and a soft linen or muslin rag ; the rag is 
dipped in the water, her finger wrapped with it and 
thus used to wash out the child's mouth, making it 
clean from any impurities that have accidentally 
got in during birth, and wiping away any collection 
of mucus. The child is now to be washed, and the 
nurse has ready a small bath or large basin, contain- 
ing water at a temperature of 90 or 95 °, olive oil 
or some similar substance for anointing the surface 
of the child, a piece of soft flannel rather than a 
sponge, and fine soap. It is a curious fact that the 
Spartan infants were not washed in water but in wine, 
as the following quotation from Plutarch shows : 
" The women did not bathe the new-born children 
with water, as is the custom in all other countries, 
but with wine, to prove the temper and complexion 
of their bodies ; from a notion they had that epi- 
leptic and weakly children faint and waste away 
upon their being thus bathed, while, on the con- 
trary, those of a firm and vigorous habit acquire 
firmness and get a temper by it, like steel." It is 
not, however, so marvelous that wine was used by 
a Pagan people in bathing the new-born, as that it 
or any other element than water has been employed 


by some Christian sects in baptism.* A reference 
to this latter use of wine is, in a Christmas carol, 
founded upon a scene in one of the Coventry Plays, 
a carol which Home, in his work entitled, " Ancient 
Mysteries Revealed," London, 1823, states was 
sung in London and other parts of England in his 
day. The carol is so simple and so musical it is 
well worth reading ; the last verse contains the allu- 
sion spoken of. 

" He neither shall be christen'd 
In white wine nor in red, 
But with the spring water 

With which we were christened." 

Returning from this digression, it is better that 
the eyelids and parts adjacent be washed simply 
with warm water, no soap being used lest the soapy 
water should come upon the eyes and cause inflam- 
mation. The head may next be washed, soap being 
employed, and after the washing, well- dried with a 
soft towel or other suitable material. Next, the 
nurse applies to those parts of the child wherever 

* The following passage in Blunt's Dictionary of Doctrinal and 
Historical Theology seems to allude to such baptism as having been 
done by some: " Water is indispensable as the matter of baptism ; 
and the sacrament, if administered in any other liquid, as wine or 
milk, would be invalid.' 1 This statement is fortified by a quotation 
from St. Thomas Aquinas. 


the secretion of the fat glands, the cheese-like var- 
nish is collected, the oil or lard which has been 
prepared, or ointment, gently rubbing it upon the 
surfaces, for by this means its ready detachment is 
secured. The nurse then dips the child in the 
bath, the head only remaining out of the water, 
keeping it there for a minute or two. Some nurses 
make the water, before immersing the child, a sort 
of soapsuds by stirring it with a cake of soap. 
After the bath the child is replaced upon the nurse's 
lap, and with flannel, soap and water she thoroughly 
washes all parts of the child and dries them. Some, 
after this washing and before the drying, have the 
bath or basin filled with clean water and again 
immerse the child. It is customarv to dust the 
body with powdered starch — the so-called toilet 
powders have starch as their essential part — but 
this is unnecessary if the drying has been well 
done; as a substitute for starch some advise talc, 
and a very good mixture of talc and magnesia is 
sold in the shops under the name of talcine. 

Bathing the baby, of course, is done in a warm 
room and in a warm place by the register or stove, 
or in front of an open fire. Until the stump of 
the cord falls off, it is not again put into a bath or 
basin, but simply given a daily sponge bath. 

Dressing the Cord. — Next comes dressing the 
umbilical cord. The time-hallowed method is to 


have a square piece of old linen rag, cut a hole in 
the centre, through which the stump of the um- 
bilical cord is to be passed ; the under surface of 
the rag has been scorched, and then smeared with 
mutton suet. The rag is now laid upon the child's 
abdomen, the remains of the cord projecting through 
the hole that has been made, then the rag is folded 
transversely, including between its folds the cord, 
next, the folding is from side to side, and the cord 
is completely wrapped up in it. Another way is 
simply to wrap the cord up in some antiseptic 
cotton ; this method has been criticised on the 
ground that the cord dries more slowly, and hence 
delay in its detachment. A better way is to have 
a small, soft piece of rag, and with this seize the 
cord between the thumb and finger just below 
where the ligature has been placed ; next cut off 
the ligated part, and squeeze out upon the rag all 
of the jelly-like substance of which so much of its 
mass is composed. The effect is that its bulk is 
much reduced, and that which remains is limp as 
a ribbon. Now apply a new ligature — the pressure 
of the thumb and finger has restrained all bleed- 
ing — and wrap the cord three or four times with a 
thin bandage (an antiseptic gauze may be em- 
ployed), and, finally, secure the roller by a thin 
piece of cord, or in some other simple way. This 
method protects against possibly offensive odor 


contributes to the infant's comfort, and hastens the 
detachment of the cord. 

After the cord is dressed and turned up toward 
the chest, the bandage is applied, securing it in 
place ; this bandage should not be tight, and can 
best be secured by a few stitches. As much as 
possible, pins are not to be used in dressing a baby; 
a needle and thread and tapes can well replace 
them in almost all c The bandage is of no 

ifter the cord has fallen off. I need not enter 
into the details of dressing an infant ; the clothing 
should give the child no discomfort, and contribute 
to keeping it sufficiently warm. Many a poor in- 
fant cries because it has not been properly dressed, 
or because a pin is pricking it, or because it is cold; 
and too often this crying is attributed to colic, and 
wrong and injurious treatment necessarily follows. 

Evacuations from Bowels and Bladder of 
Infant. — Passing urine and an evacuation from the 
bowels generally occur within a few hours after 
birth. Soiled diapers must be promptly removed, 
and not reapplied until well washed and thoroughly 
dried ; the parts of the child that have been soiled 
are to be washed with soap and water, dried, and 
then powdered. 

Applying Infant to Breast. Artificial Food. — 
Some would apply the child to the breast immedi- 
ately after it has been washed and dressed, but 


ordinarily it is better to wait until the mother has 
had a few hours' rest. The application may be 
repeated again in four or five hours, until the estab- 
lishment of an abundant secretion of milk, which 
usually takes place on the third day ; after that a 
nursing once in two hours should be the rule during 
the first few weeks ; only, then, as well as after- 
ward, let there be in the night an interval of absti- 
nence for five or six hours, more especially in the 
mother's interest. The nurse will not waken a 
baby at a particular hour for nursing; as a rule, 
if it sleeps it does well, and it is not wise to disturb 
its rest. Early application of the child to the breast 
secures for it a fluid known as colostrum, which 
acts as a laxative; this application, too, makes 
nursing easier for both mother and child, by giving 
suitable form to the nipple. In most cases, no 
artificial nourishment is required in the two or 
three days before milk is abundantly secreted : in 
rare instances a little warm water sweetened with 
sugar maybe given, or if there be great dc!ay in the 
secretion of milk, a mixture of one part of cow's 
milk and two of water, sugar of milk being used 
to sweeten it, may be employed. But remember, 
the physician should be consulted in all cases before 
resorting to constant feeding of the baby. 

Infant should not Sleep with the Mother. — 
The infant ought not to occupy the bed of the 


mother except when nursing; let it have its own bed, 
either crib or cradle. There are many reasons for 
this rule, among which are, that with its head often 
covered by the bedclothes, when it is lying with 
the mother, it breathes an impure air ; occupying 
such a place, there is danger of the mother in her 
sleep turning over on it, and it perishes ; and, again, 
if the child be restless, suffering from minor or 
temporary distress, the mother frequently applies 
it to her breast, seeking to lull its pain by the 
diversion of taking food, and thus it is taught bad 
habits, and the mother is deprived of needed rest. 

Falling Off of the Cord, and Dressing the Raw 
Surface. — The stump of the cord falls off in five to 
seven days, and the surface, left somewhat raw after 
its detachment, may be dressed with, any simple 
ointment, such as oxide of zinc, cosmoline, etc., to 
which it is well to add some antiseptic, or it may 
be dusted with a mixture of salicylic acid one part, 
starch four parts. 

Attentions to the Mother. — In regard to the 
nurse's attentions to the mother during the puer- 
peral period, the most important things are rest, 
food, cleanliness. A moderately darkened room, 
perfect quiet, comfortable position and properly 
arranged personal and bed clothing, will be the 
most important concerns directly under the nurse's 
control to secure repose for her patient. The skin 

FOOD. 85 

of the puerpera is remarkably active, and, especially 
when she awakes after sleeping a short time, is 
covered with perspiration; now, while care is taken 
that no exposure to cold occurs to check this 
activity of sweat glands, let equal care be taken 
not to make it excessive by having the room hot, 
or by heavy bed-clothes. Visitors ought not to 
be admitted for at least a week, and the puerpera 
is to be carefully guarded against all mental excite- 
ment and worry. 

Food. — It is generally advised that the patient 
have a very restricted diet the first few clays of her 
lying-in. But the question of articles of food 
depends upon the individual condition, her desires, 
and her habits. If greatly exhausted, she needs 
beef tea, animal broths, milk, chocolate, and such 
nutritious solid food as her appetite craves and she 
can digest. Ordinarily, the first food given may be 
tea and toast, or milk toast, a cup of chocolate, 
well-boiled rice, etc. There is no objection to her 
having mutton or chicken broth, or oatmeal gruel. 
If she is getting on well, solid animal food, such as 
chicken, roast beef, or a mutton chop, may be 
taken, if desired, the third clay, or even the second. 
The low diet formerly directed for the puerperal 
woman, under the notion that thereby fever was 
prevented, is not now usually enjoined by doctors ; 


such a diet hinders convalescence, and rather in- 
vites than averts disease. 

Use of Catheter. — Retention of urine not un- 
commonly follows a difficult and prolonged labor, 
especially in case of a primipara. This retention 
does not result, as taught in one of the popular 
nurse's manuals, from paralysis of the urethra, but 
of the bladder, or in most cases, from great swelling 
of the urethra ; the bladder not being sensitive to 
the presence of urine, no effort to empty it is in- 
vited, or the organ may have partially lost its con- 
tractile power, or the resistance from the swelled 
urethra cannot be overcome. The patient should 
be urged, in six or eight hours after labor, to try to 
empty the bladder, a warmed bed-pan being placed 
under her to receive the discharge ; if she cannot 
succeed lying upon her back, on no account is she 
to be permitted to sit up in bed and try in this posi- 
tion to empty the bladder, lest dangerous bleeding 
from the womb occur; some, however, advise that 
she be helped upon her hands and knees for the 
purpose, but if she be very weak this is a violent 
change and trying posture. If the patient cannot 
urinate in twelve, or at most eighteen, hours after 
labor, the catheter must be used; the nurse — her 
hands and the instrument being dipped in an anti- 
septic solution first, and completely disinfected — 


washes away with the creolin solution, for example, 
all secretions from about the urethral opening, lest 
some septic matter be carried by the instrument 
into the bladder, and a very troublesome inflam- 
mation result, then introduces the instrument. 
The catheter must be used twice or thrice in the 
twenty-four hours, as the rapidity of the secretion 
of urine or the discomfort of the patient may 
require ; in most cases the bladder regains its 
power with the first evacuation of the bowels, which 
probably the doctor will direct to have made three 
days after labor ; in some cases, however, the use 
of the catheter must be continued a week or longer. 
Local and General Bathing. — For the first few 
days the nurse bathes the external parts twice a day 
with an antiseptic solution, but gives no vaginal 
injections unless directed by the physician, and this 
he will probably not do unless the lochial discharge 
becomes offensive. Washing the hands and face 
of the patient once or oftener daily will be done, 
but I imagine giving her an entire sponge bath 
every day, as advised by some, is rarely done, and 
is not necessary, — once in two or three days will 
usually be often enough for this attention. All 
soiled cloths or clothes, and discharges from uterus, 
bladder or bowel, must be promptly removed, and 
the air of the room thus and by suitable ventila- 
tion kept pure; of course, if a window be opened 


for this ventilation the patient must have an addi- 
tional cover to prevent her becoming chilled; but 
I am persuaded that there is far more danger to 
the puerpera from dirt than there is from cold, and 
that the dread poison of septic infection has too 
often been concealed under the term " taking cold." 

The bandage is examined occasionally to see that 
it has not become wrinkled, or made into a cord in- 
stead of a band ; a clean one may be put on daily, 
the old one being removed and washed. 

Temperature of the Patient. — The temperature 
of the patient is taken morning and evening, and 
the record shown the doctor at his visit. It is not 
necessary for the nurse to inform the patient what 
her temperature is, and indeed, in some instances 
of abnormal elevation, she ought not to be told. 
In Mr. Tait's private hospital he has the nurses use 
Centigrade thermometers exclusively, and thus 
avoids giving any real information to patients, for 
though the nurse may tell them their temperature, 
they are no wiser after than before, and this is 
certainly in many cases quite advantageous. Prob- 
ably puerperae are peculiarly liable to abrupt in- 
crease of the body heat from mental impressions, 
such as great worry or grief. Just as there are 
emotional tempers, there are also emotional tem- 
peratures. Of course such elevations are fugitive, 
and are not regarded with any anxiety. Again 


there may be sudden and great increase in the tem- 
perature from physical causes acting temporarily, 
which is also fugitive, and not important. I have 
seen a woman five days after labor, simply from the 
violent action of a cathartic, have her temperature 
suddenly elevated to I02 c . In all cases of marked 
increase of temperature, the nurse had better use 
the thermometer not merely morning and evening, 
but also at intervals of three hours, so that she may 
know whether the elevation continues, increases or 

Time when the Patient may Leave her 
Bed. — It is usual for a woman to sit up the ninth 
day, and this popular rule has some scientific 
support in the fact that generally in nine days the 
uterus has so lessened in size that it has entered 
the pelvis. But a longer rest in bed is better for 
the majority of women ; indeed, for those who are 
not strong and vigorous, sitting up should be 
deferred until eighteen or twenty days. Neverthe- 
less, there can be no objection, the doctor's appro- 
val having been obtained, to the puerpera being 
transferred from the bed to the lounge, where she- 
may recline during the day or part of it, after the 
first nine or ten days. If the red flow returns after 
having quite disappeared at the usual time, when 
the patient gets up, a return to bed is plainly in- 


Occupation during Convalescence. — As con- 
valescence progresses the puerpera may be allowed 
to read for a short time, or engage in any light oc- 
cupation, such as a little sewing, while still in bed. 
At the end of three weeks, everything going on 
well, she begins to walk a little, but at first confines 
this exercise to her room. After four weeks she will 
probably be down stairs, gradually resuming her 
household duties, grateful to the nurse for her 
faithful services, it is to be hoped, and giving her 
adequate compensation, and grateful, too, for that 
which money cannot pay, the nurse's ever-living 
sympathy and ever-loving kindness. 


After-pains. — Following a second and subse- 
quent child-births, rarely after the first, contractions 
of the womb causing more or less suffering and 
known as after-pains, generally occur. These pains 
are more severe in women who have borne many 
children, especially if the intervals between the 
births have been short. They usually begin within 
an hour or two after the labor is over; they con- 
tinue a few seconds, or one to two minutes, and 
may recur at irregular intervals, sometimes fifteen 
minutes, half an hour or longer; they are excited 
or increased when the infant nurses. In most 
instances their severity greatly abates, or they may 
have disappeared within twenty-four hours, but 
they are sometimes protracted to the second or 
third day; in some instances women have asserted 
that after-pains caused greater suffering than child- 

In case after-pains occur in the absence of the 
physician, and he has left no directions as to their 
treatment, the nurse can do somewhat for their 
relief by repeatedly applying two or three folds of 
a towel that has been wrung out of hot water or 
whiskey, and by gently rubbing the uterus. 



Antiseptics. — As stated in the first lecture, the 
antiseptics that have been generally used in obstet- 
rics are carbolic acid and corrosive sublimate ; the 
strength of the solution of the former most em- 
ployed is three per cent., and that of the latter I to 
1000-5000 of water, the strongest solution being 
only used for rendering the hands aseptic, and the 
weakest for intra-uterine injections, while 1 to 2000 
may be employed for vaginal injections and for 
bathing the external organs and for antisepticizing 
napkins, or pads applied to the vulva for receiving' 
the lochia. Nevertheless, I have seen mercurial 
poisoning in two instances follow injections into 
the vagina with a solution of the strength last men- 
tioned, the injections being used twice a day; and 
I believe it would be better, if a solution of this 
strength is employed so frequently, to immediately 
follow it by washing out the vagina with water that 
has been boiled. 

Creolin is a product of the distillation of coal, a 
dark, syrupy-looking fluid, making, when mixed 
with water in the proportion usually employed, 
1-2 to 100, a milk-like compound; it was employed 
by Professor Winckel in the Munich Frauen Klinik 
last year, to the exclusion of all other antiseptics 
in midwifery practice. A 2 per cent, solution was 
used for cleansing the hands of physicians and 
nurses, for disinfecting catheters, for bathing the 


external genitals and for vaginal injections ; for 
intra-uterine injections the strength was i to 1.5 per 

cent. My friend, Dr. J. Clifton Edgar, of New 
York City, states that in sixty deliveries occurring 
during his term of service as one of the resident 
physicians of the Klinik, the results were quite as 
good as those had from corrosive sublimate. My 
own experience with creolin in obstetrics, though 
only employing it for a few months, is quite satis- 
factory. The solution of creolin testifies to its pre- 
sence by appeal to two senses, sight and smell, and 
therefore there is much less danger of making mis- 
takes than when a solution like carbolic acid, which 
is known only by odor, or that of corrosive subli- 
mate, which is both odorless and colorless, is used. 
If an ointment be required for fingers or hand, or 
for instruments, an excellent one may be made by 
adding four per cent, of creolin to benzoated lard. 

Antiseptic Napkins and Pads. — At the Mater- 
nity of the Philadelphia Hospital the napkins em- 
ployed for the puerpera are, of course, first thor- 
oughly washed, then they are dried, and after this 
dipped in a 1 to 2000 corrosive sublimate solution, 
and again dried before being used. At the Pre 
Retreat, which may be justly declared a model 
maternity, one of the best in the world, Dr. Joseph 
Price, who is in charge of the institution, employs 
antiseptic pads. The antiseptic pad is made of a 


piece of thin, cheap cotton material, which has been 
antisepticized, and is about twenty-four inches 
square ; it is first folded diagonally upon itself, as if 
the beginning of a cravat ; next, there is laid upon its 
doubled surface a piece of waxed paper nine inches 
by three, upon this antiseptic jute, and finally a 
layer of antiseptic cotton above this. Then the 
muslin is so folded that it has something of a boat- 
shape, the cotton being exposed ; a few coarse 
stitches secure the form and keep the cotton, jute 
and paper in place. When the pad is applied its 
ends are fastened to the bandage behind and before, 
and the cotton rests directly upon the vulval open- 
ing. The pad weighs about one ounce and a half, 
and can be made probably at an expense of about 
five cents ; four pads will be needed the first twenty- 
four hours following labor; of course, after use 
the pad is burned. 

Bed of the Puerpera. — In maternities straw 
beds are frequently employed. Certainly, such a 
bed has some advantages, for after being used, the 
emptied bed-tick can be put in boiling water and 
thoroughly washed, while the straw is burned ; of 
course, only fresh and clean straw for refilling the 
bed-tick is used. 

For protecting the under sheet and the bed of 
the puerpera there is placed beneath her a blanket 
twice folded on itself, which is then included be- 


tvveen the double folds of a sheet; these must be 
removed whenever the sheet is in the least soiled, 
and clean blanket and sheet put in their place. 

Breasts, Infant's, Care of. — Ordinarily, the 
breasts of the infant require no special attention ; 
but sometimes, in both male and female, and prob- 
ably more frequently in the robust than in the 
feeble, there occurs swelling of the breast, about 
the time the cord falls off, the organ becoming as 
large as a pigeon's egg, and a small quantity of 
milk is secreted : the secretion may continue ten 
or a dozen days, and then spontaneously disappears. 
In some instances the breast becomes inflamed, and 
the inflammation ends in the formation of matter ; 
it is doubtful, however, if these results occur unless 
violence has been used in the useless effort, too 
often made by mother or nurse, to " squeeze out 
the milk." The only treatment ordinarily proper 
will be occasional bathing the breast with a little 
warm water. 

Breasts, the Mother's, Care of. — As previously 
advised, early application of the infant to the breast 
is desirable, that is, after the mother has had a 
few hours' rest following delivery. If the right 
breast is to be used — as a rule, the infant takes 
the milk from only one breast at a nursing during 
the first few weeks — the mother turns upon her 
right side, partially supporting the infant's head 


with her arm ; in this position the nipple almost 
drops into the child's mouth, and there is no 
pressure upon its nose preventing the access of air, 
as there is if the child is laid upon the mother's 
chest while she is upon her back. Water sweetened 
with sugar may be put upon the nipple, and thus 
invite the child to nurse. After each nursing the 
nipple is to be washed with cold water, and if it is 
very tender it may once a day be lightly brushed 
with compound tincture of benzoin ; but the nurse 
making this application must let the coating dry 
before covering the organ, and, especially, she must 
not, as some nurses do, apply a rag immediately 
after the benzoin has been used, for then the re- 
moval of the rag at the next nursing will cause 
pain, and contribute pretty surely to inflammation 
of the nipple. In the intervals of the nursing two 
or three folds of soft muslin or linen are laid upon 
each breast to protect them, and to absorb any dis- 
charge ; these must be removed as soon as they 
become damp, either from perspiration or from the 
oozing of milk, fresh ones being put in their place. 
To keep the breasts hot by applying layers of cot- 
ton or of flannel, from the fear of " taking cold," 
does not comfort the patient nor avert danger. 

If the breasts become very much swelled at the 
first secretion of milk, a properly applied bandage, 
or supporting them each by a silk handkerchief, the 


ends being fastened round the neck, will frequently 
be beneficial. It would be better for the patient, 
preventing or lessening such excess of milk-making, 
to take for a day or two little fluid food, and to 
drink very little water. 

Protection of the nipples from fissures and ex- 
coriations may further be sought by the daily 
application of a little cocoa butter or other non- 
irritating ointment, by not allowing the infant to 
keep the nipple for a long time in its mouth, alter- 
nately sucking and sleeping, and, if the nipples 
become very tender, by the early use of a nipple 

Catheter. — The Nelaton catheter I think the 
one most convenient, and while I have adopted the 
common statement that the instrument should be 
kept in an antiseptic solution in the intervals be- 
tween its use, it seems to me this is a needless 
precaution ; if the instrument, both before and after 
its use, is thoroughly washed in a two per cent, 
solution of creolin, for example, it will be perfectly 

Colostrum. — This is the name given to the fluid 
found in the breasts the first two or three days of 
the puerperal period ; its chemical composition is 
almost the same as that of milk, the chief difference 
between the two fluids being in the relative pro- 
portions of the constituents. It acts as a laxative 


to the infant, and therefore is needed for the pur- 
pose of purging off the meconium. This laxative 
action has been attributed by some to the larger 
quantity of salts it contains, but by others to its 
greater richness in glandular elements, which cause 
indigestion; the latter hypothesis seems the more 

Constipation. Colic. — An infant usually has 
one, two or three evacuations from its bowels every 
twenty-four hours, and if this is not the fact more 
or less suffering generally results from the failure, 
especially attacks of colic frequently occur. The 
nurse can do something toward overcoming this 
constant constipation by spending a few minutes 
each day in gentle massage of the child's abdomen ; 
daily rubbing the abdomen with sweet oil is ad- 
vised by some ; for immediate relief the most 
common means is the familiar cone of soap ; a 
suppository of soap and cocoa butter, or an injection 
of two teaspoonfuls of sweet oil, may be used where 
immediate relief is not required ; when colic is pres- 
ent, the injection of warm water and soap is prefer- 
able. In addition to the last means stated for the 
relief of colic, a few teaspoonfuls of the warm 
infusion of anise, or fennel seed, or a few drops of 
the milk of asafoetida, may be given, and cloths 
wrung out of warm water applied to the abdomen. 
But let a nurse beware of quieting this or other 


pain in the infant by whiskey or paregoric, or by 
" cordial " or " soothing syrup," or any other of the 
nostrums that are so often, and generally so inju- 
riously, employed. 

Convulsions, Puerperal. — Convulsions rarely 
occur during pregnancy, in labor or in the puerperal 
state, without premonitory symptoms, so that the 
physician has been using means to avert them, or 
possibly he may be present during the first attack. 
Should an attack come when he is absent, the 
nurse's duties are very simple, and chiefly negative. 
She will make no effort to restrain the violent 
movements of body or limbs of the patient, for such 
effort is foolish and futile ; but she will endeavor to 
prevent the patient from injuring herself, and the 
chief injury is biting the tongue, an accident very 
liable to occur, and sometimes a very serious one. It 
is best prevented by means of a large napkin, which 
is so folded that it may be stretched across the 
open mouth, pressing the tongue within the jaws, 
if it has been thrust out, and keeping it from pro- 
truding until the convulsion is over. 

Food for the Infant. — Nature intended that 
during the first months the infant should be nour- 
ished from the mother's breasts ; but some mothers 
do not have sufficient or suitable milk, in rare cases 
the secretion fails entirely, and in still others mal- 
formation of the nipples, or general disease may 


render maternal nursing impossible or unwise. A 
healthy wet-nurse, one whose milk agrees with the 
child, and who will be faithful in her duties, is the 
best substitute. But such wet-nurses are very diffi- 
cult to obtain, and, therefore, it will most frequently 
be necessary in these emergencies to give artificial 
food. As an encouragement to this course I cannot 
do better than quote the words of my friend, Dr. 
Louis Starr, who in a recent volume * has said : 
11 There can be no doubt, though the statement is a 
bold one and seemingly contrary to nature, that, 
taking the average, infants brought up by hand are 
better developed and enjoy more perfect health than 
those completely breast-fed." This statement, how- 
ever, is only correct when the infants living upon 
human milk have not sufficient quantity or suit- 
able quality. The following formulae he commends 
as suitable in preparing artificial food for the first 
few weeks : quoting, I can give them warm endorse- 
ment from my own knowledge of their value. 
" Diet during the first week : — 

Cream, 2 teaspoonfuls 

Whey, f 3 teaspoonfuls 

Water (hot), 3 teaspoonfuls 

Milk sugar, ^ teaspoonful. 

For each portion ; to be given every two hours from 5 A.M. to 1 1 P.M., 
and in some cases once or twice at night, amounting to twelve 
fluidounces of fluid per diem. 

* Hygiene of the Nursery. Philadelphia : P. Blakiston, Son & Co. 
I W T hey is made by adding three teaspoonfuls of wine of pepsin 


"Diet from the second to the sixth week : — 

Milk, I tablespoonful 

Cream, 2 teaspoonfuls 

Milk sugar, % teaspoonful 

Water, 2 tablespoonmls. 

For one portion ; to be given every two hours from 5 A.M. to II P.M., 
amounting to seventeen rluidounces of flood per diem." 

I am sure that the possession of these directions 
will be helpful to many an obstetric nurse, not only 
in those cases where the child must be exclusively 
hand-fed, but in the more numerous ones where 
the mother has so scanty a supply of milk, or this 
milk is of such inferior quality that the infant cries 
with hunger, this crying too often attributed to 
colic or to crossness, but which is very promptly 
charmed away by a few meals of food prepared as 
above directed supplementing the food obtained 
from the mother. 

Hemorrhage, Uterine. — The only form of severe 
bleeding from the womb of which it is thought 
advisable to speak is that occurring after labor. 
This may happen at an interval of an hour or two, 
or some days after delivery. The nurse, of course, 
has the physician at once sent for, but, meantime, 
she endeavors to obviate in some degree the inju- 
rious consequences of the loss of blood by lowering 

to a quart of warm fresh milk, and placing the mixture near the fire 
for two hours : the curd is then removed by straining through muslin. 


the patient's head, taking away pillow and bolster, 
and raising the foot of the bed. She seeks to stop 
the flow by exciting the uterus to contract through 
friction and compression, by means of the hand 
upon the abdomen. If ergot be at hand, a tea- 
spoonful of the fluid extract may be administered 
in water, if the patient be not suffering from sick 
stomach, and a copious hot water injection into the 
vagina may be given. 

Lochia.— This term, applied first by Hippocrates 
to the discharge occurring after childbirth, is the 
plural of a Greek adjective signifying u of or be- 
longing to childbirth." The lochia last usually from 
two to three weeks, and are at first quite red, con- 
sisting chiefly of blood; the quantity progressively 
diminishes, and after the first three days the red 
color gradually disappears, and the fluid becomes 
thinner and more watery. After seven or eight 
days it is paler, may be cream-like in consistence, 
or transparent, like melted glass or the uncooked 
white of an e££. Where strict attention to clean- 
liness and to the use of antiseptics is given, little or 
no odor of the discharge will be observed. The 
nurse ought to observe the quantity, the color, and 
especially the odor of the discharge, reporting at 
once to the physician if the latter becomes offen- 
sive, or if there are other deviations from the nor- 
mal course. 


It is not uncommon for the lochia to diminish, 
or even be absent for a few hours, during the estab- 
lishment of the secretion of milk, and then the 
quantity is greater, for example, on the fourth than 
on the third day. While the usual duration of the 
flow is, as has been stated, two to three weeks, in 
some instances it stops at the end of a week ; but 
such early cessation is never a cause of anxiety un- 
less other symptoms are present; nevertheless, the 
physician should be informed of this occurrence. 

Meconium. — This name is given to the first dis- 
charges from the infant's bowels, because of their 
resemblance in color and consistence to the juice 
of the poppy ; they are viscid and brownish or 
greenish. The first discharge usually occurs within 
ten or twelve hours after birth, and is followed by 
others for four or five days, when the evacuations 
have become a light yellow. It would be proper 
for the nurse, in case the discharge did not appear 
within twenty-four hours after birth, and the infant 
was apparently suffering from the retention, to use 
a soap suppository or a rectal injection of warm 

Septicaemia. — Although the correct etymologi- 
cal signification of the word septicaemia expresses 
the entrance of the infection into the blood, yet it 
is common to speak of puerperal septicaemia as 
including all cases of septic infection occurring in 


puerperal women, no matter whether the poison 
gets access to the organism through venous or 
through lymphatic vessels. The disease will vary 
in its manifestations according to the avenue of 
entrance, the quantity of the poison, the suscepti- 
bility of the patient, and the promptness with 
which proper therapeutic means are employed, so 
that it may be mild or severe, brief or protracted. 
But underneath the various manifestations and 
forms, and the differing degrees of danger, lies this 
great truth, of such practical importance that it 
should be ever remembered by doctor and nurse, 
the disease is contagious, and the poison conveyed 
by unclean hands or instruments from one woman 
in whom the disease is mild, issuing in speedy 
recovery, to another puerpera, may prove in her 
grave and rapidly mortal. 



Ifgf^ Dealing exclusively in books on medicine 
and collateral subjects, we are able to give special 
attention to supplying books for nurses. We have 
a large stock of works on Nursing, Hygiene, 
Popular Medicine, etc., Temperature Charts, etc. 
In purchasing from us Nurses receive the same 
benefits as medical students. 

Catalogues of Books on Medicine, Dentistry, 
Pharmacy, Chemistry, etc., free, upon application. 

Special attention given to orders to be forwarded 
to a distance, by mail or express. Upon receipt of 
the price, any book will be delivered, free, to any 

P. Blakiston, Son & Co., 



A Manual for the treatment of Surgical and other Injuries, 
Poisoning and various Domestic Emergencies, in the absence of the 


Surgeon to the Out- Door Department of the University and Presbyterian 
Hospitals, Philadelphia ; Editor of the Medical and Surgical Reporter. 

Third Edition, Enlarged. i2mo. . 



Cloth, .75 

Preliminary Remarks. 
Obstructions to Respiration. 
Foreign Bodies in the Eye, Nose and 

Fits or Seizures. 
Injuries to the Brain. 
Effects of Heat. 
Effects of Cold. 
Wounds of all kinds, including the 

bites of Dogs, Cats, Snakes, Insects, 

Railroad and Machinery Accidents. 

Hemorrhage— Bleeding. 

Special Hemorrhages. 

Transportation of the Injured. 

Poisons and their Antidotes. 

Domestic Emergencies, includes Chol- 
era Morbus, Vomiting, Diarrhoea, 
Nervous Attacks, Earache, Tooth- 
ache, Asthmatic Attacks, Croup, 
etc., etc. 

Signs of Death. 

Supplies for Emergencies. 

The Surgical and Medicine Case, 
their contents and use, Bandaging, 
Poultices, etc. 


*#* This book should be in the possession of every head of a 
family, Nurse, Manufacturer, Police Lieutenant, Sea Captain, Hos- 
pital Steward, School Teacher, Druggist, etc. etc. 

" Several attempts have been made to prepare a volume which would serve 
as a handy manual for reference in the time of need, in the absence of a doctor, 
but none have succeeded better than the present little work. It should be in the 
hands of all officers charged with the public conveyance of passengers, to be 
read, in preparation for emergencies, and afterward to serve as a book of refer- 
ence." —North Carolina Medical Journal. 

" This little manual contains simple directions for the preliminary treatment 
of accidents to all parts of the body and of such diseases as persons are suddenly 
seized with. Without profuseness or an unintelligible vocabulary, it contains in 
a small space a deal of useful information." — New York World. 

" This is a revised and enlarged edition, with new illustrations, of the manual, 
explaining the treatment of surgical and other injuries in the absence of the phy- 
sician. The simple and practical suggestions of this little book should be known 
to every one. Accidents are constantly occurring, and a knowledge of what 
should be done in an emergency is very valuable. Such a hand-book should be 
in every home, placed where it can always be found read'ly. — Boston Journal 
of Education. 


CULLINGWORTH. A Manual of Nursing, 
Medical and Surgical. By Charles J. Cul- 
lixgworth, m.d., Physician to St. Mary's Hospital, 
Manchester, England. Third Edition. With 18 
Illustrations. i2mo. Nearly Ready. 


A Manual for Monthly Nurses. Third Edi- 
tion. 32mo. Cloth, .50 

" This small volume is written as a supplement to the author's well-known 
work on nursing. It treats only of the conditions of pregnancy and labor. It 
is clear in its statements, and will prove of great value to those whose duty it 
is to care for women during and after confinement." — N. Y. Medical Jour. 

DOMVILLE. Manual for Nurses and others 
engaged in attending to the sick. By Ed. J. Dom- 
ville, m.d. Sixth Edition. With Directions for 
Bandaging, Preparing and Administering Enemata, 
Fomentations, Poultices, Baths, etc., Recipes for 
Sick-room Cookery, Tables of Weights and a Com- 
plete Glossary of Medical Terms. Cloth, .75 

" Domville's Manual" is high authority with those "who know," and as 
the later editions were rapidly exhausted, the appearance of this is welcome. 
The book is a small one, and convenient for household reference as well as for 
its study in the training school." — Public Ledger, Philadelpliia. 

HOOD. Lectures to Nurses on the Commence- 
ment of Disease. By Donald Hood, m.d., m.r.c.p., 
Physician to the West London Hospital, etc. 121110. 

Cloth, Si. 00 

" As interesting as they are instructive. * * * * The book, as a whole, is 
likely to prove helpful to nurses by increasing their knowledge of the reason and 
purpose of their duties." — London Lancet. 


LUCKES. Hospital Sisters and Their Duties. 
By Eva C. E. Lucres, Matron to the London Hos- 
pital ; Author of "Lectures on Nursing." 121110. 

Cloth, $1.00 

" I consider it to be a book which supplies a much needed want in nursing 
literature. As the moral as well as the technical standard for nursing women 
becomes higher, so will all such help toward the attainment of absolute excel- 
lence become of increasing value." — From the late Alice Fisher, of the Train- 
ing School for Nurses of the Philadelphia Hospital. 

" Sound, practical common sense characterizes this valuable contribution to 
the literature of nursing." — Dublin Medical Journal. 

" To those aspiring to become hospital sisters this book will be invaluable." 
— Therapeutic Gazette. 

TEMPERATURE Charts for Recording Tem- 
perature, Respiration, Pulse, Day of Disease, Date, 
Age, Sex, Occupation, Name, etc. 

In pads of 50, each .50 

MURRELL. Massotherapeutics. Fourth Edi- 
tion, Or Massage as a Mode of Treatment. By 
Wm. Murrell, m.d., f.r.c.p., Lecturer on Phar- 
macology and Therapeutics at Westminster Hospi- 
tal, Examiner at University of Edinburgh, Physician 
to Royal Hospital for Diseases of the Chest. 
Fourth Edition. Revised and Enlarged. Illus- 
trated. i2mo. Cloth, $1.50 

PARVIN. Obstetric Nursing. Lectures delivered 
at the Training School for Nurses of the Philadel- 
phia Hospital, by Theophilus Parvin, m.d., Pro- 
fessor of Obstetrics and Diseases of Women and 
Children in the Jefferson Medical College, Obstetri- 
cian to the Philadelphia Hospital. 121110. Cloth. 


WYTHE'S Dose and Symptom Book. The Physician's 
Pocket Dose and Symptom Book. Containing the Doses and 
Uses of all the Principal Articles of the Materia Medica, and Offici- 
nal Preparations. By Joseph Wythe, a.m., m.d. 17th Edition; 
revised and rewritten, containing Tables of Weights and Meas- 
ures, Rules for Proportioning the Doses of Medicines, Hints on 
Treatment, etc. Just Ready. Cloth, Si. 00 

Leather, with Tucks and Pocket, Si. 2 5 

YEO'S Manual of Physiology. 3d Edition. A Manual for 
Students. By Gerald F. Yeo, m.d., f.r.c.s., Prof, of Physiology 
in King's College, London. 3d ed.; revised and enlarged by the 
author. With new illustrations. 321 carefully printed Wood En- 
gravings. A Glossary and Complete Index. Crown Octavo. 

Cloth, $3.00; Leather, 53.50 

* # * Every intelligent person should have a knowledge of Physiology ; to the 
successful nurse it is a necessity. Prof. Yeo's manual is a practical, concise 
statement of the facts of the science, elementary so far as to the using of plain 
language and the avoidance of discussions of theories useless to any but the ad- 
vanced student. A complete glossary adds to its usefulness. 

POTTER. Compend of Materia Medica, Therapeutics and 
Prescription Writing, arranged in accordance with the last re- 
vision U. S. Pharmacopoeia, with special reference to the Physio- 
logical Action of Drugs. Fifth Revised and Improved Edition, 
with Index. i2mo., Cloth, Si. 00 

*** Mtdtum in Parvo. This compend will be found more useful perhaps as 
a reference book when in doubt about the administration of a drug, its physio- 
logical action, etc., than to study from, as its statements are short, practical 
and concise. It is used largely by medical students and physicians who wish 
to keep abreast of the latest discoveries. 

BEALE. On Slight Ailments ; their Nature and Treatment. 
By Lionel S. Beale, m.d., f.r.s., Prof, of the Practice of Medi- 
cine in King's Medical College, London Second Edition. En- 
larged and Illustrated. 8vo. Cloth, Si. 2 5 


American Health Primers 


Professor of Surgery in ihe Jefferson Medical College, Fellow of t lie College 
of Physicians of Philadelphia, etc. 

12 Volumes. 32mo. Attractive Cloth Binding, each 50 Cents. 

This Series of Health Primers is prepared to diffuse as widely 
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correct habits of living, and take care of themselves, their children, 
employees, etc. 

tions. By Chas. H. Burnett, m.d., of Philadelphia, Aurist to 
the Presbyterian Hospital. Illustrated. 


Richardson, m.d., of Philadelphia, late Professor of Hygiene 
in the University of Pennsylvania. 

Wilson, m.d., of Philadelphia, Lecturer on Physical Diagnosis 
in Jefferson Medical College. 

Illustrations. By George C. Harlan, m.d., of Philadelphia. 
Surgeon to the Wills (Eye) Hospital. 

V. THE THROAT AND THE VOICE. With Illustrations. 
By J. Solis Cohen, m.d., of Philadelphia, Lecturer on Diseases 
of the Throat in Jefferson Medical College, and on the Voice in 
the National School of Oratory. 




ton Osgood, m.d., of Boston, Editorial Staff Boston Medical 
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tions. By J. W. White, m.d., d.d.s., of Philadelphia, Editor 
of the Dental Cosmos. 


Wood, Jr., m.d., of Philadelphia, Clinical Professor of Nervous 
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IX. OUR HOMES. With Illustrations. By Henry Harts- 
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lustrations. By L. D. Bulkley, m.d., of New York, Physician 
to the Skin Department of the Demilt Dispensary and of the New- 
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XI. SEA AIR AND SEA BATHING. With Illustrations. 
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*J k Each Volume 50 cents, in Attractive Cloth Binding. 


Hygiene of the Nursery, 






Clinical Professor of Diseases of Children in the Hospital of the University 
of Pennsylvania ; Physician to the Children's Hospital, Phila. 

Second Edition. Enlarged and improved. 


i2mo. 280 Pages. Cloth, $1.00. 

*35* This book contains very complete directions for the proper 
feeding of infants: 1st, From the maternal breast. 2d. By wet- 
nurse, including rules for choosing the woman. 3d, Artificial 
Feeding. This part of the subject is elaborated carefully, so as to 
include everything of importance, and will be found of great service 
to the monthly nurse. General and specific rules for feeding are 
given, and Diet Lists from the first week up to the eighteenth 
month, with various recipes for artificial foods, peptonized milk, etc. 
Directions for the sterilization of milk, substitutes for milk, prepara- 
tion of food for both well and sick children, nutritious enemata. 
etc., and the general management of the Nursery. 

" Dr. Starr's experience as Clinical Professor of Diseases of Children in the 
University Hospital and as physician to the Children's Hospital, with his 
eminence in private practice among juvenile patients, is ample warranty for the 
satisfaction and instruction to be found in this book. The dedication " To my 
Little Patients," shows the sympathy with which the writer enters upon the 
important discussion. The volume is entirely in the modern lines of preventive 
medicine — more important in the nursery than at any other time of life ; because 
constitution building is going on then and there. In this admirable treatise, so 
clearly written that no mother need be deterred by fear of medical terms from 
making its teaching her own, Dr. Starr carries out the highest ideal of the 
modern physician, so to regulate the lives of his professional clients that the 
occasions are less frequent when he need be called in to act for serious compli- 
cations. * * * * With the numerous good treatises on the subject that 
Philadelphia publications include, this intelligent work is the most distinguished, 
as it is also the latest work on complete Hygiene of the Nursery." — The Led- 
ger, Philadelphia. 





H Parvin* 
)|)[9 Lectures on obstetric 

P2£ nursing.